What people eat depends on what is available. When people like me write about food, we usually address people who have the economic capability to eat whatever they want. That is important because many diseases that we see today that were relatively rare even a generation ago are often the result of dietary factors. Obesity, adult onset diabetes, heart artery blockages, and even some cancers can be blamed on diet -- but only on a diet that either contains too many calories or too much of a particular type of food.

However, in a country like Pakistan the major diet related problems are due to inadequate amount of food. There are three major aspects of a diet that need to be considered. First is the total number of calories, second are the different types of nutrients like carbohydrates, fat and proteins, and third are the micronutrients like vitamins and minerals. A diet that does not have enough calories for survival is really just a starvation diet and it will inevitably result in death. So if you do not consume enough calories then it does not matter what your diet is made up of.

Fortunately in Pakistan, outright starvation is rare but sadly inadequate nutrition is becoming more common as population increases and long established patterns of living get disrupted. Most people that grew up in villages especially in the Punjab were rarely deprived of adequate nutrition. This was not just a function of economic wellbeing but also a consequence of a communal lifestyle that has mostly disappeared. And changing patterns of religion and accepted norms of piety has something to do with it also.

Before I go any further, let me talk a little bit about babies dying in the Thar region of Sindh. When babies die but parents survive then something is very wrong. Especially so when the babies are infants depending on breast feeding for nourishment.

There have been some reports that infant starvation can be due to inability on the part of the mother to nurse properly. Every time there are reports of these babies dying from malnutrition, no mention is made of the health of the mother or the presence of other problems like diarrhoea that make it impossible for the baby to absorb enough nutrition. In short properly breastfed babies of healthy mothers do not starve to death.

So now back to the problem of insufficient nutrition. Starvation causes death but a marginal lack of calories in a growing child is extremely problematic. Even in countries like the United States, there are areas where children go hungry for part of the day. Such children show poor growth, decreased learning ability and as they grow into adulthood they demonstrate inability to become productive workers. It is an interesting question whether we are seeing something like that happening in many of our youth in Pakistan that come from poor families.

A lot is said these days about the rising tide of public piety and the increasing enrolment of children in religious seminaries. But there are some interesting side effects of both these tendencies. In Lahore, for instance, literally nobody has to go hungry. There is ongoing distribution of free food at places like Data Sahib (the shrine of Sufi saint Ali Hajweri). Many restaurants also distribute free food at the end of the day. As far as the seminaries are concerned, they provide free clothing, food and lodging besides some education to children that are enrolled. Most of these children come from poor families that are unable to provide for their children. So religiosity it would seem has a positive impact on nutrition available for the poor and especially for the children.

In a statement above, I alluded to the negative change in nutrition for the poor in villages due to changing norms of religious piety. I have never lived in a village except as a small child so I have no direct memory of what happens there. However, during a long flight from the US to Pakistan I sat next to a Pakistani doctor who grew up in a village. As we discussed the state of the poor in our rural areas he made a very interesting point. In the ‘old days’, there was a profusion of religious festivals and religious rites that included distribution of food to the poor. He suggested that these sort of things happened often enough that even the ‘poor’ managed a ‘nutritious’ meal once a week.

However, he pointed out that the arrival of a more austere version of religion brought in by people returning from abroad cut down these religious incidents and with it decreased the access the poor had to a decent meal. That said, the nutritious meal probably included meat and some sugary stuff. So in line with modern feeling about nutrition, it would seem that the poor were better off now since they consumed less meat or sugar, presuming of course that they met their caloric needs adequately with less ‘rich’ and expensive stuff on a daily basis.

One of the major problems in Pakistan is poverty. Even among those not considered poor, many live just above the poverty line and in both these groups adequate calorie intake is a problem. But it is just not possible for any government however pro-people it might be to feed everybody that needs extra food. And any such system even if possible will be extremely susceptible to fraud and misuse. But what might be possible is that while the country awaits the promised improvements in our economy and standard of living, at least children in the public school system get one and if possible two free meals a day.

Feeding children in public schools will only be effective if there are enough public schools for all the children of school going age and of course if all the children of school going age actually attend school. Both of these pre-requirements are never going to be met as long as the present government is in place.

For most of our ‘successful’ politicians, universal education, poverty alleviation and food sufficiency are not political priorities. Transportation infrastructure and ‘named’ mega projects is what politicians want. Anyway the very poor and the starving don’t really come out to vote. And even if they do vote, these votes can be bought by a few kilos of food stuff spread around a week or two before election.

Back to food, and to food for those that can actually afford more than a few types of food and then have to choose between them. For many years the scientific community had gone totally nuts about what to eat to prevent things like heart disease. Fortunately, some common sense has returned to the food debates. The consensus today is that people can eat most things they want but in moderation. However, processed foods, junk food and fast foods should be consumed as less as possible.

Advice given by Michael Pollan, a journalism professor and a food writer, seems entirely appropriate. He says: "Eat food. Not too much. Mostly plants". He also says: "Don’t eat anything your great grandmother wouldn’t recognise as food".