ॐ
आः नो भद्राः कर्तव्यो यन्तु विश्वतः
Aa no Bhadraha, Kratvyo Yantu Vishwataha:
Let noble thoughts come to us from every side Rk Veda I.89.1
Gurubhyo Namaha, Harihi OM!
Dear and respected Chairpersons and members of the of the Working group of the Second edition,
I have the deepest respect for the brilliance, the humanity and intellectual honesty of all the dedicated scientists in NIN , members of the Food and Nutrition Security Community, Solution Exchange Group and Dean, St. John’s Research Institute , Bangalore, those who exerted extreme due diligence to produce this powerful honest statement of facts to base their recommendations to achieve the goals listed on page 9.
I would like to respectfully share my initial response to a report about these Guidelines in the Indian Express by Ms. Annona Dutt, and my specific detailed responses after reviewing the PDF closely and doing additional research.
DietaryGuidelinesforNINwebsite.pdf- A manual- A section placed with great urgency and concern upfront immediately following Preface and Introduction entitled “Current Diet and Nutritional Scenario provides an excellent exposition of the facts on the ground in pages 4-7 in the PDF.
“The proportion of households with energy inadequacy was about 70%, while that with protein inadequacy was about 27%. Thus, in the cereal/millet-based Indian dietaries, the primary bottleneck is energy inadequacy and not the protein, as was earlier believed. This dietary energy gap can be easily reduced by the poor by increasing the quantities of habitually eaten foods. The authors give specific details.” These dry data sets have powerful personal concomitants to the babies, children, mothers and care givers especially the Interns and House surgeons and CAS on Duty who have to engage with children in agony, emaciated dehydrated with swollen Bellies, suffering from Marasmus, Kwashiorkor and do cutdowns and try to replace and replenish the nutrients and fluids while trying to manage the needs of many other children with serious illness and respiratory infections who were admitted from the Walk in OP and sometimes through the Casualty dept. Sometimes we had 30-35 admissions just for Dand V [Diarrhea and Vomiting.] Sadly, in GGH [Govt General Hospital] we lost scores of children on a weekly basis who were dear to their families and who expected the highly regarded staff trained at MMC would restore to health and return them to their families. Sadly, and to our great disappointment at that stage, we were almost as helpless in altering the course of their precious babies' lives as they were at that moment in time. People like me and some of my colleagues were both physically and mentally exhausted and moved to tears at times for instance when our repeated attempts to open the IV lines fails and we need to get senior staff[ in my case I was lucky my older sister at time was a PG in Pediatrics and worked at GGH and her close friends were ready to help to help and when we lose a few helpless babies. We, in the midst of our sorrow, had to help the grieving parents who lost their precious babies that day and the next and next without respite. Sadly, and to my great distress 60 plus years after I completed my training in Madras Medical College /Govt. General Hospital, the menace of the WASH concerns is debilitating and causing premature deaths of our precious babies three generations later. This must end, we must attain the goals of SDG 2030 [both 3.1 and especially 3.2 earlier than 203 especially since Karala and another 10 states have accomplished these goals now. That is a third of the number of States in our beloved Motherland- Bharat that is India. Redouble efforts to attain the goals of Swachh Bharat Abhiyaan [SBM] that was launched on the 149th birth anniversary of Bapu Oct 2, 2014. We have as a Nation failed to achieve th goals across most of our nation by the 150th birth anniversary of Bapu in 2019. I am praying and begging that we all do what we can to achieve the goals of SBM and attain the SDG goals 3.1 and 3.2 by the 160th birth anniversary of our beloved Bapu. Ba aur Bapu Amar Rahe!
Our MMC Teachers Professors S.T. Achar and Prof Balagopal Raju also developed nutritional supplements which we could supply initially to precious ones who survived that could be produced easily for commodities they could procure in the Locales they resided in. In our Internship as a part of Public health rotation we went to mofussil areas and learned to work with Local folks to clean up their sources of drinking water and how to set up latrines that can be safely established to keep the individuals and communities safe. Mahatma Gandhi was successful in creating such latrines and protecting water supplies in his Ashrams in South Africa and in India and during his various campaigns. Bapu was fanatical [appropriately] about these aspects in addition to specific recommendations on food that was prepared and consumed of creating his version of Dr. MLK Jr’s Beloved Communities. I learned how to improvise from reading Bapu’s writings on creating safe and healthy communities. It is very distressing and saddening to read 60 plus years since I began as an intern to treat babies admitted with D and V when I was training and witnessing the devastating effects of chronic infections, diarrhea and vomiting and resulting malnutrition and under nutrition including premature deaths of precious innocent neonatal and under 5 children.
This section [Pages 4-7]and the rest of the Dietary Recommendations of NIN in the manual is a great start to state the facts authentically and build on our gains achieved by several states perhaps a third of all the states of my motherland- Bharat that is India and address the WASH concerns once and for all without the next generation- the children of the survivors of current children who suffered D and V as well as consequences of Stunting, on future brain functions including intellect. It is too much to endure for our wonderful brothers and sisters and their children over and over again. Me Must achieve the SDG 2030 3.1 and 3.2 in the next two years we cannot afford to wait emotionally, economically and in terms of national security if more people in India are practicing open defecation than there are living in today in the huge state of California because of the all the complications that we are all too familiar with.
I had hoped the Swachh Bharat Abhiyan that was launched in 2014, would have met with greater success in the intervening ten years. In fact, the campaign was supposed to yield the desired goals in 2019. I offer this this link: Swachh Bharat Abhiyan | Prime Minister of India (pmindia.gov.in). Poojya Pradhan Mantri Modiji stated emphatically, “A clean India would be the best tribute India could pay to Mahatma Gandhi on his 150th birth anniversary in 2019,” said Shri Narendra Modi as he launched the Swachh Bharat Mission [SBM] at Rajpath in New Delhi. On 2nd October 2014, Swachh Bharat Mission [145the birth anniversary] was launched throughout length and breadth of the country as a national movement [ Bapu’s 145th birth anniversary]. The campaign aims to achieve the vision of a ‘Clean India’ by 2nd October 2019.” I offer this powerful image of the launch of the SBM that always inspires me to work harder as did our beloved Bapu to did to help build independent, clean, healthy and strong communities across the length and breadth of India in the remotest areas that could no longer be subjugated by foreigners. [https://www.pmindia.gov.in/wp-content/uploads/2015/03/gov-track5.png]
“On the other side of the spectrum of malnutrition, diet-related non-communicable diseases are commonly seen. With increasing urbanization, energy-rich diets containing higher amounts of fat and sugar, which also provide less dietary fibre and complex carbohydrates, are being frequently consumed, particularly by high-income groups. In addition, the urban population is turning to be more sedentary with little physical activity. Consumption of alcohol, providing empty calories, and tobacco use is also common among them. Hence, prevalence of disorders like obesity, heart disease, hypertension (high blood pressure) diabetes and certain types of cancers is on the increase. Widespread malnutrition is largely a result of dietary inadequacy and unhealthy lifestyles. Other contributing factors are poor purchasing power, faulty feeding habits, large family size, frequent infections, poor health care, inadequate sanitation and low agricultural production. The population living in the backward and drought-prone rural areas and urban slums, and those belonging to the socially backward groups like scheduled castes and tribal communities are highly susceptible to undernutrition. Similarly, landless laborers and destitutes are also at a higher risk. The most rational, sustainable and long-term solution to the problem of malnutrition is ensuring availability, accessibility and consumption of adequate amounts of foods. Dietary guidelines help to achieve the objective of providing optimal nutrition to the population. I am providing additional supporting documents.”
Page 9 has a sterling list of the prescribed DIETARY GOALS 1. Maintenance of a state of positive health and optimal performance in populations at large by maintaining ideal body weight. 2. Ensuring adequate nutritional status for pregnant women and lactating mothers. 3. Improvement of birth weights and promotion of growth of infants, children and adolescents to achieve their full genetic potential. 4. Achievement of adequacy in all nutrients and prevention of deficiency diseases. 5. Prevention of chronic diet-related disorders. 6. Maintenance of the health of the elderly and increasing the life expectancy.
I would like to start my responses by presenting these vital aspirational and long delayed goals of millions of children and mothers and their State and National Govt’s all around World:
Targets of Sustainable Development Goal 3 (who.int)
Targets of Sustainable Development Goal 3 to ensure healthy lives and promote well-being for all at all ages
3.1. Maternal mortality
By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
3.2. Neonatal and child mortality
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.
The Sustainable Development Goal (SDG) target for child mortality aims to end preventable deaths of newborns and children under 5 years of age by 2030. All countries are striving to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-5 mortality to at least as low as 25 deaths per 1,000 live births 123. This ambitious goal aims to ensure that more than 97.5% of all newborns survive their first five years, regardless of where they are born 4.
Six (6) States/ UT have already attained SDG target of NMR [Neonatal Mortality] (<=12 by 2030): Kerala (4), Delhi (9), Tamil Nadu (9), Maharashtra (11), Jammu & Kashmir (12) and Punjab (12).
Eleven (11) States/UT have already attained SDGs target of U5MR (<=25 by 2030): Kerala (8), Tamil Nadu (13), Delhi (14), Maharashtra (18), J&K (17), Karnataka (21), Punjab (22), West Bengal (22), Telangana (23), Gujarat (24), and Himachal Pradesh (24).
SDG. Goal 3 – Means of implementation for the targets. These strategies can promote the health of the mother and her unborn babies and safeguard the health of the babies both boys and girls under age 5. Some of the states in India particularly Kerala have been implementing plans successfully in these domains already. Two Critical area not mentioned here is achieving full literacy especially of women and girl children and ensuring health care access to both children especially girl children by planning and implementing screening and intervention by the equivalent of Community Health Workers in the CT to ensure the babies are all screened for risk factors, detect and intervene early to ensure vaccination schedules are adhered too for instance, and to repair the nutritional consequences of Diarrhea and Upper respiratory illnesses.
3.a. Tobacco control
Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate. [This can help reduce the exposure of unborn babies and babies in the neonatal period and in the highly vulnerable first five years of life to secondhand smoke as direct negative effects of the smoking by the mothers of unborn babies.]
3.b. Medicines and vaccines
Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries. Provide access to affordable essential medicines and vaccines in accordance with the Doha Declaration on TRIPS and Public Health, which affirms the right of developing countries to the fullest use of the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS agreement) regarding flexibilities to protect public health and, in particular, provide access to medicines for all.
3.c. Health financing and workforce
Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States. Kerala has planned and achieved success in this area.
3.d. Emergency preparedness
Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.
Target 3.8. Universal health coverage
This target can be seen as an overarching one that supports the achievement of the other targets. It is derived from the Millennium Development Goals, the new targets and the means of implementation.
I offer these resources to more fully understand the vast dimensions of the problems of malnutrition, impact of extremely prevalent practice of public defecation, poor sanitation and severe inaccessibility of portable water, chronic infection and inanition which can shorten lives and stunt not just height but also brain development across all and learn what has been tried and what steps needs to be urgently undertaken to make it possible of one of fastest growing economies in the world, soon to be pass Japan as the fourth largest economy in the world to attain the long elusive SDG.
First, I would like to share my initial responses to the report filed by Ms. Annona Dutt about the Dietary Guidelines promulgated by NIN before presenting my report on Child Malnutrition in India that I have been working on for some years.
1. Health Promotion- Initial Response to NIN-ICMR Dietary Recommendations - Report-Annona Dutt 1.docx
2. In this document that I developed after some study :Child Malnutrion in India.docx I offer several vital resources that helped me to more fully understand the vast dimensions of the problems of malnutrition, impact of extremely prevalent practice of public defecation, poor sanitation and severe inaccessibility of portable water, chronic infection and inanition which can shorten lives and stunt not just height but also brain development across all and learn what has been tried and what steps needs to be urgently undertaken to make it possible of one of fastest growing economies in the world, soon to be pass Japan as the fourth largest economy in the world to attain the long elusive SDG.
I have the deepest respect for the brilliance, the humanity and intellectual honesty of the Chairpersons and members of the of the Working group of the Second edition who promulgated these profoundly informative and in parts encouraging but distressing facts of life in our Pavitra Matra Bhoomi- Bharat that is India.
I am sharing my responses to a call from 2025 Dietary Guidelines Advisory Committee at MyPlate. I have been interacting with this Agency of the US Federal Govt for more than a decade. About the time I began to formulate and share my observations and personal experiences on Health promotion Strategies and managing Emotional distress from about 2007 or so. Health Promotion - Educational Materials (psychiatristsites.com) and TreatmentRecommendationsforRestoringWellbeing: Managing Depression. There is more on this in Resource #1 above.
Response to request for Comments from My Plate. Gov. 2025 Dietary Guidelines Advisory Committee (velandymanoharmd.com)
I would like to close with this profound precept Dharma Rakshati Rakshitah from Yaksha Prashna that is exemplified in in the selfless efforts of all those who made this great report from the NIN especially those who confirmed and published the facts on Pages 4-7 about the powerful, devastating effects of major problems due to Sanitation concerns and access to clean water, undernutrition and Malnutrition- High rates of Neonatal and Under 5 mortality and serious irreversible neurocognitive changes. This must End as soon as humanly possible-
“Dharma Rakshati Rakshitah…”
Yaksha Prasna- more information -Items 53 a, b, and c. from The Wonder of It All, Amen (velandymanoharmd.com)
Source: Yaksha Prashna, the Story of the Righteous Crane - DocsLib
“Dharma Rakshati Rakshitah…”
Dharmo Rakshati Rakshitah. [Those who protect Dharma are protected by Dharma] Yudhistara offered this rationale for choosing Nakula as the sibling he wanted the Yaksha to restore to Life. Yaksha offered Yudhistara a boon for responding to all the challenging philosophical enquiries made by the Yaksha instead one of the Heroic brothers Arjuna or Bhima particularly since the clouds of War were on the Horizon. Arjuna, Bhima and Yudhistara were children of Kunti, Nakula and Sahadeva are children of Madri. They were the two wives of their father King Pandu. Yaksha asks Why dost thou wish Nakula to revive?” Yudhishthira said, — “If virtue is sacrificed, he that sacrificest it, is himself lost. So, virtue also cherisheth the cherisher. Therefore, taking care that virtue by being sacrificed may not sacrifice us, I never forsake virtue. Abstention from injury is the highest virtue, and is, I mean, even higher than the highest object of attainment. I endeavor to practice that virtue. Therefore, let Nakula, O Yaksha, revive! Let men know that the king is always virtuous! I will never depart from my duty. Let Nakula, therefore, revive! My father had two wives, Kunti and Madri. Let both of them have children. This is what I wish. As Kunti is to me, so also is Madri. There is no difference between them in my eyes. I desire to act equally towards my mothers. Therefore, let Nakula live?” The Yaksha said, — “Since abstention from injury is regarded by thee as higher than both profit and pleasure, therefore, let all thy brothers live, O bull of Bharata race!” Dharmo Rakshati Rakshitah. [Those who protect Dharma are protected by Dharma.
This is very much in harmony with this ennobling precept: Paropakaraya Punyaya, Papaya Parapeedanam
“Whatever conduces to the good of others is noble deed and should be followed” Seva / Sewa - Selfless Service! (sanskritimagazine.com)
And
Matthew 25:40
King James Version (KJV)
40 And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.
And
Matthew 22:39 sets a divine Context for this report.
“Love thy Neighbor as thyself”:
36Master, which is the great commandment in the law? 37Jesus said unto him, Thou shalt love the Lord thy God with all thy heart, and with all thy soul, and with all thy mind. 38This is the first and great commandment. 39 And the second is like unto it, Thou shalt love thy neighbor as thyself. 40
And
This great teaching of Sant Kabir Das Ji: “Moho Kahan Doondo re Bande.”
मोको कहाँ ढूढे रे बन्दे?
मैं तो तेरे पास में
And Finally
For me this precept has been a profoundly grounding and sustaining in my trials and tribulations
He has showed you, O man, what is good; and what does the Lord require of you but to do justice, and to love kindness and to walk humbly with your God? Micah 6:8
https://en.wikipedia.org/wiki/Daridra_Narayana
This essential teaching reinforces my faith-based axiom:
Daridra Narayana was formulated by Swami Vivekananda and Popularized by Bapu.
Daridra Narayana or Daridranarayana is an axiom enunciated by the late-19th century Indian sage Swami Vivekananda, espousing that service to the poor is equivalent in importance and piety to service to God. This exposition was a result of Vivekananda's wanderings in the country for two years, when he personally experienced the privation of the lower classes in the country.[1][2] Vivekananda then referred to feeding the poor as "Narayana Seva",[3] and preached for "Daridra Narayana Seva", meaning service to the poor as service to Narayana. "Narayanam Devam adevam isam - Lord Narayana, the Supreme controller and the ultimate Soul of all existence, venerated as the Supreme Being in Vaishnavism.
This dictum of Daridra Narayan Seva was extended to the medical field to treat the poor when, in 1972, the Swami Vivekananda Medical Mission came to be established. The motto of this mission is what Vivekananda had said: "To reach Narayana we must serve the Daridra Narayana, the starving millions of the land. Feel for them, pray for them. Strive for the relief and uplift of the suffering and miserable brethren."[10]
Extending the practice of this religious axiom, a new idiom has been coined "Where Daridra Narayan meets Vaidya Narayana" (Vaidya means medicine) by a leading doctor in Coimbatore, in South India who has urged "Whenever a 'Daridra Narayan' (poor person) knocks on the door, one must be ready to perform the duty of a 'Vaidya Narayan' (doctor) in the fullest capacity.
I believe in these concepts as we are so moved by our Master within and all around us to seek and strive to selflessly serve the manifestations of the precious fragments of the Supreme Brahman as described
by Lord Sri Krishna in Discourse X, Verses 41 and 42.this from verse 41 “…तत्देवावगच्छ त्वं मम तेजोंऽशसम्भवम् I, 42 “…विष्टभ्याहमिदं कृत्स्नमेकांशेन स्थितो जगत् I Thus it is important for me to regard everyone I encounter as My Lord Narayana and to take special care to regard Jan seva is Janardhana seva, Manava seva is Madhava seva, Jan seva is Janardhana seva !! whenever any opportunity to serve appears from whatever direction and at whatever time of day or night and from any and all manifestations of my Lord Narayana [I have offered excerpt from the Bhaasya of SBG by my Lord Adi Sankara Bhagavata of Kaladi, Kerala, India. He has graced my consciousness from a very early stage of my life-perhaps age 10 or so through very troubling and highly risk laden circumstances facing my teams, patients and me and when I am formally chanting prayers prompting helpful guidance. I have described some of the experiences that shaped and sustained by Sadhana Path from periods of Despondency [ Vishad] to periods of transcendence, satisfaction and joy on my journey to elusive destination of Enlightenment. https://www.velandymanoharmd.com/TempleBookTouchstonesonthepathfromdespondencytoliberationandTranscendence.en.html.
This is an analogy of the Mental and Emotional journey Arjuna bravely undertook from the Verse 47 of first Discourse crouching on the ground beside the Chariot parked between the two armies on the field of Dharma -Kurukshetra after casting his Gandiva and irresistible arrows, “… विसृज्य सशरं चापं शोकसंविग्नमानस l to Verse 73 of the Eighteenth Discourse of the Srimad Bhagavad,”… स्थितोऽस्मि गतसन्देह: करिष्ये वचनं तव l
What all of you have been doing especially in formulating with great brilliance and humanity and presenting to world in this PDF is to embody the noble ideals in the Foundational truths that I have presented in this Link that I too, have endeavored to exemplify in my life. Foundational Truths exemplified in the eBook Sadhana Path (velandymanoharmd.com)
My website velandymanoharmd.com has several related posts including links to my two copyrighted eBooks https://www.amazon.com/Sadhana-Path-Velandy-Manohar-MD-ebook/dp/B0BRVVCY62 and The Wonder of It All, Amen (velandymanoharmd.com) This is the Companion book focused on promoting Inter- faith awareness and sustaining discussions about Spiritual traditions around the world.
I am grateful for and awed by the success of the collective efforts of each and every one of your good selves who put your heart into your tasks and publish this very important Documents
I welcome your esteemed responses.
Yours respectfully,
Velandy Manohar, MD
Distinguished Life Fellow, Am. Psychiatric Association