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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 99-106

Current Paradigm Shifts in Diet: A Review of the Chinese Traditional Diet


Department of Health and Nutrition Research, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Date of Submission27-Oct-2020
Date of Acceptance20-Jan-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Prof. Hong- Yi Shen
Department of Health and Nutrition Research, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai 20120
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_13_21

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How to cite this article:
Chang YC, Liu X, Xu Q, Wu JZ, Shen HY. Current Paradigm Shifts in Diet: A Review of the Chinese Traditional Diet. Chin Med Cult 2021;4:99-106

How to cite this URL:
Chang YC, Liu X, Xu Q, Wu JZ, Shen HY. Current Paradigm Shifts in Diet: A Review of the Chinese Traditional Diet. Chin Med Cult [serial online] 2021 [cited 2021 Jul 27];4:99-106. Available from: https://www.cmaconweb.org/text.asp?2021/4/2/99/320164




  Introduction Top


It is estimated that by 2050, the world's population will reach around 10 billion and our global food demand is projected to increase by 60%–110% between now and then.[1],[2] Current food systems will be incapable of meeting the growing demand for healthy, safe, and sustainable foods. At present, around 2.5 billion people around the world are undernourished, overweight, and micronutrient deficient, in one or more ways.[3]

Since the beginning of the century, all aspects in our social structures have changed dramatically including personal eating habits and lifestyles due to the progresses in such areas as science and economy. As a result, unbalanced dietary patterns are rampant across all levels of society, as indicated by increased consumption of meats, dairy products, and processed foods. It is estimated that from 2005 to 2050, the world's total meat consumption will increase by 85%, and by 2050, the total energy intake from animal foods will rise to 23% under the current trend.[4] These numbers suggested that the overall dietary pattern is transitioning into a Westernized diet, where the main energy sources lean heavily toward animal proteins and such a major dietary shift is currently happening in China. China has always been an agricultural-based society, in which cereals and grains have always been the main staples [Figure 1]. However, since reforms initiated in 1979, the population has experienced a complete paradigm shift including the nutrition transition away from the grain-oriented traditional Chinese diet, which many scholars consider the most healthy diet when food supplies are adequate.[5],[6],[7] Animal protein consumption tripled since 1970. The per capita meat consumption reached 90.28 g/d in 2016 compared to 31.2 g/d in 1970, reaching a peak in 2002 (131.9 g/d), during which period the obesity rate has increased as well.[6],[7] The dietary proportions of animal proteins and edible oils grew considerably; fat exceeded 30% of total energy in 2015 as fast food consumption also increased.[6],[8] Since 2012, the prevalence of noncommunicable diseases (NCDs) among adults has been significant; during the same period, the rate of hypertension increased to 25.2%; diabetes increased to 9.7%; death from diabetes complications continue to rise; chronic illnesses accounted for 86.6% of total deaths.[6] In short, China has transformed quickly from its traditional dietary structure to a stage of overnutrition and is now confronted by emerging nutrition-related NCDs.
Figure 1: Steamed whole grain rice with azuki red beans, chestnuts, and enoki mushrooms

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The unbalanced, unhealthy diet is characteristically high in calorie, with an excessive ratio of saturated fats and sugar combined with a low intake of complex carbohydrates and dietary fiber, in addition to low levels of physical activity. It is also the main cause of the global rise in obesity and NCDs, and is closely related to the development of Type-2 diabetes, hypertension, cardiovascular diseases, and cancers. Globally, 1.9 billion adults are overweight, of which one third are considered obese; 8.4% of the adult population worldwide suffers from diabetes, and this is projected to rise from 450 million to 629 million by 2045.[9],[10] Poor dietary pattern is linked to obesity and to the overall morbidity and mortality in the world.[1],[11]

While our food supply systems are directly related to our dietary patterns, they are also the major contributors of greenhouse gas emissions.[12] The agricultural sector alone contributes 16%–27% of global greenhouse gas emissions, freshwater pollution, soil degradation, and loss of biodiversity.[13] If the current dietary consumption trend that favors animal-derived foods continues, global greenhouse gas emission from the agricultural sector is projected to increase by 32% by 2050.[4] Research shows that current meat and dairy food consumption must be drastically reduced. The sooner we adapt to plant-based diets, the sooner these detrimental emissions can be reduced by 30%–55%.[1],[4] Negative climate impacts from plant-based diets have been found to be 20%–30% lower than those from regular meat-based diets, and up to 45%–50% lower with vegan diets.[14] Essentially, in order to lower greenhouse gas emissions caused by food production, we must re-examine the amount and type of food groups necessary for maintaining optimal human health in a long-term.


  Characteristics of a Global Diet Top


We urgently need a worldwide transformation of our current dietary pattern and food production system. Numerous scientific reviews are urging us to adopt to a more sustainable dietary pattern, food production methods, and environmental system. The “universal reference diet” published by the EAT-Lancet commission is a quantitative reference guide that is intended to assist policy makers in achieving the Great Food Transformation for a wider healthy public and sustainable planet. It is a dietary framework that is applicable to “all food cultures and production systems in the world, with a high potential of local adaptation and scalability.”[1] The EAT–Lancet reference diet is rich in fruits and vegetables, with protein and fats sourced mainly from plant-based foods, unsaturated oils from fish, and carbohydrates from whole grains [Table 1]. According to the EAT-Lancet commission, in order for a successful dietary transformation, plant-based ingredients have to be our main energy source. The consumption of grains, beans, nuts, fruits, and vegetables must be increased to more than double that of the current recommendations by 2050. Processed foods, refined sugar, and red meats, all of which are not conducive to health, must be reduced to less than half of the current global consumption.[1] These are just a few guidelines presented by the commission for the future of health and environmental sustainability.
Table 1: Composition of the EAT-Lancet reference diet

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After examining the “universal reference diet,” we find that the traditional Chinese dietary pattern aligns very well within its framework. We believe these dietary patterns can be readily adapted geographically and culturally. To understand its potential for implementation, consider that the current Chinese population is close to one-fifth of the world's population (18.58% or 1.4 billion). Adapting to this traditional dietary pattern could greatly impact global health and environment.[15] The five-grain diet, also known as “five-grain for nourishment (五谷为养),” was first mentioned in Huang Di Nei Jing (《黄帝内经》Huangdi's Internal Classic) over 2000 years ago. It has since greatly influenced the ubiquitous Chinese culture of food-medicine homology by providing sound and practical suggestions for food, diet, nutritional therapy, and dietary taboos since it was first mentioned. Currently, “Dietary Guidelines for Chinese Residents” is a dietary pattern reference guide with modern nutritional concepts, such as recommended food group intakes, and is consistent with the five-grain diet [Table 2].[16]
Table 2: Composition of the dietary guidelines for Chinese residents

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  Similarities between the Five-grain Diet and the Universal Reference Diet Top


We compared the two diets and found many similarities between them. However, one must read the five-grain diet in its original text in reference to Chinese Medicine theories in order to fully appreciate the insights on foods and their combinations for enhancing health. We also found that several texts are consistent with modern nutritional discoveries. Moreover, due to its long presence in Chinese history, the five-grain diet is readily adaptable to the framework of the universal reference diet.

In Chapter 22 of Huangdi's Internal Classic: Su Wen “Si Qi Tiao Shen Da Lun” (《素问·四气调神大论》Basic Questions “Comprehensive Discourse on Regulating the Spirit in Accordance with the Qi of the Four Seasons”), it is written that,

The five grains provide nourishment;

the five domestic animals provide enrichment (benefit);

the five fruits provide support;

the five vegetables provide filling.

When they are consumed in appropriate combinations of their qi and flavors,

they serve to supplement the essence and to enrich the qi.[17]

In her dissertation, Shen cited several historical references in the evolution and categorization of the “five grains,” in which the author explained that many scholars have differing annotations on the “five grains.”[18] For example, Li Shizhen (李时珍)'s Ben Cao Gang Mu (《本草纲目》Compendium of Materia Medica) listed 73 kinds of grains, hemp, and beans which were all categorized under “grains (谷部).” In China's long history of cultivating grains and cereals, there have been records of many ancient cultivars that we no longer consume today. Due to the country's extensive geographical characteristics, subtypes of these cultivated plants differ by territory. As a result, each scholar also defined his own “five grains” in different regions during different periods. Therefore, it is meaningless to clearly define the “five” types. However, the five grains are translated as wheat, millet, chestnut, rice, and legumes in Huangdi's Internal Classic. Understanding such evolution in the historical records, we will instead focus on the ideology behind “five grains for nourishment” as a whole; and “five + food groups” will be used as a general term to encompass all groups (grains, animals, fruits, vegetables) as they are consistent within the “nourishment (养)” concept in the Huangdi's Internal Classic.

First, the importance of grains as qi and energy contributors is outlined in both the five-grain diet and the universal reference diet. In traditional Chinese medicine (TCM) theory, vitality (yang qi 阳气) is important to defend the body from disease, whereas qi and essence (精) are created when foods are adequately consumed. As stated in Lin Shu “Wu Wei” (《灵枢·五味》Miraculous Pivot “The Five Flavors”), “when no grain enters, after half a day the qi will weaken. After a full day they are present only minimally.”[19] (谷不入半日则气衰,一日则气少矣。), which means that adequate intake of grains is essential to sustain the human body with energy. Recent nutritional research have proven that whole grain cereals should be our major energy source, and these grains should account for a large proportion of a healthy diet. In fact, cereals, legumes (such as soy products), seeds, and nuts are often consumed as the main energy contributor as carbohydrates in many culinary traditions around the world.[1] Traditionally, grains, cereals, and soybean are indispensable in a Chinese meal, because they are believed to be the source of vital energy. They should be the main component in a modern meal; both the universal reference diet and the traditional Chinese diet have suggested them as the main energy focus albeit there is a small difference in proportion. For example, the universal reference diet suggested that energy from carbohydrates should be no more than 60% of total energy intake, while carbohydrates should contribute more than 50% as suggested by the “Dietary Guidelines for Chinese Residents” – largely based on the five-grain diet as mentioned before. The universal reference diet suggested around 232 g/d of whole grains; 50 g/d of other legumes such as beans, lentils, and peas; and up to 50 g/d of nuts for those on a full plant-based diet. The “Dietary Guidelines for Chinese Residents” suggested between 250 and 400 g/d of various whole grains and 25–35 g/d of nuts and soy products. In addition, both diets specifically emphasize the importance of the soybean. The universal reference diet even suggested to include 25 g of soybean daily due to its association with reducing the risk of breast cancer from its high polyunsaturated fat content. For the traditional Chinese diet, it is already a major staple in it.[20]

Second, studies have revealed that meat consumption affects the human body differently in different stages of life. During childhood development and sarcopenia, the natural process of age-related muscle loss in older people, the intake of high-quality protein (usually as animal proteins) is beneficial for cell growth and replication. However, studies have also concluded that consuming animal protein in adulthood may be unnecessary to maintain overall health and could increase the risk of cancer.[21] If we analyze the etymology of “five animals for the benefit,” the word, “benefit (益)” implies that meat should be consumed in moderation and that excess can cause harm in the long run. In English, we can translate the Chinese character 益 as replenish, supplement, or benefit. For example, in benefit, bene- in Latin, means “good, well” while -ficus means “making, doing,” “eating meat does well for the body.”[22] If we take the dictionary meaning for replenish, “fill a vacancy,” we can interpret it as nutrients from animals helping the body to refill bodily fluids and essence lost from daily activities.[23] Nutrients in meat can also “supply a deficiency;” when carbohydrates are insufficient as an energy source, the body transforms protein molecules into power instead. However, if excessive energy converted from protein is no longer needed, it is stored as fat. Unlike children and the old, the need for extra nutrients usually remains stable during adulthood, as overall growth has plateaued; therefore, excessive meat consumption is unnecessary for the overall health. Therefore, we should interpret “five animals for the benefit” as consuming adequate meat to be beneficial at different stages of life. This observation is comparable to the inclusion of red meat in the “universal reference diet,” in which red meat consumption should be <28 g/d; other meats should be mindfully consumed, up to 84 g/d, for overall health.

Third, “the five fruits provide support; the five vegetables provide filling,” we know that fruits and vegetables help normal bodily functions as they contain complex sugars, dietary fibers, and antioxidants that are required for overall health. To better understand the five-grain diet's conceptual interpretation of fruits and vegetables, we should first recall the functions of the liver and gallbladder under TCM theory:

The three main TCM functions of the liver are (1) direct and lead the way for qi; (2) support digestive qi (in which modern science has shown during digestion the gallbladder secrets bile acids); and (3) regulate emotions. Acting within the yin-yang relationship, the liver (yin) and gallbladder (yang) are also interdependent, opposing, mutually transformative, and mutually consuming [Table 3].
Table 3: Characteristics of yin and yang

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Next, we analyze the Chinese etymology of the word “support (助),” which is commonly associated with the Chinese phrase synonymously 佐助. Here, 佐 is pronounced the same as “left (左)” in Chinese, representing yang and the gallbladder. In the Oracle Bone script and Seal script 助 is depicted with a hand (ψ) on the right side, representing yin and the liver [Table 4]. Together, the liver (yin) and gallbladder (yang) function hand-in-hand to support the digestive system. This helps to clarify the linkage among liver, fruits and vegetables that the support of fruits and vegetables to the human body, which is done through the aid of the liver system. As modern science has also proven, “soluble fiber from fruits and vegetables binds with bile acids (secreted by the gallbladder) in the small intestines, increasing fecal bile salt excretion and thus reducing cholesterol, blood lipids, and blood glucose,”[24] and “fruit polyphenols have inhibitory potential on reducing postprandial glycemia,”[25] where glucagon is produced by the liver. Diets high in fruit and vegetable consumption are shown to improve the gut microbiota and anti-inflammatory effects for nonalcoholic fatty liver disease.[26] We conclude that the mutual functions of the liver and the gallbladder are closely associated with the consumption of fruits and vegetables. The necessity of fruits and vegetables in a well-balanced diet is very well established in research. Benefits of increasing fruit and vegetable consumption include lowering caloric intake, increased intake of dietary fiber, reduced intake of saturated fat and cholesterol, higher intake of polyunsaturated and monosaturated fatty acids, increased intake of antioxidants and micronutrients, phytosterols, and more.[27] To summarize, fruits and vegetables with their micronutrients and polyphenols, are able to fill the body where it needs it the most, and supports the normal function of the human body. After analyzing the recommendation of the “Dietary Guidelines for Chinese Residents,” we calculated that, up to 50% of total weight comes from fresh fruits and vegetables, with only a small part coming from poultry, meat, and fish and this is consistent with the recommendation from the universal reference diet.
Table 4: Analyzing the etymology of the functions of the five-grain diet

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  Difference between the Five-grain Diet and Universal Reference Diet Top


Both diets present the idea that diversifying plant foods is essential for good health. However, the universal reference diet only gave a general overview of various benefits of plant-based food. Little information is given on its practice. In comparison, the message for meaningful food combination is outlined in many places throughout the Huangdi's Internal Classic. For example, the last phrase in the “Attainment of Nourishment” is by far the most important concept and is often overlooked when planning a balanced diet, which is supported by additional references recorded in various chapters of the Huangdi's Internal Classic.

When they are consumed in appropriate combinations of their qi and flavors,

they serve to supplement the essence and to enrich the qi.[17]

In fact, “Five” as elements of nature have been widely used in the Huangdi's Internal Classic to describe the relationship between the nature (四气) and flavor (五味) of food, as well as the five elements (五行) and five zang organs (五脏), which is how the traditional diet structure “five grains for nourishment” has been initially proposed. In Miraculous Pivot “The Five Flavors,”

The (flavors of the) five grains: nonglutinous rice, sweet. Sesame, sour. Large beans, salty. Wheat, bitter. Yellow millet, acrid.

The [flavors of the] five fruits: dates, sweet. Plums, sour. Chestnuts, salty. Apricots, bitter. Peaches acrid.

The (flavors of the) five domestic animals: ox, sweet. Dogs, sour. Hogs, salty. Sheep, bitter. Chicken, acrid.

The (flavors of the) five vegetables: mallows, sweet. Garlic, sour. Legumes, salty. Shallots, bitter. Onions, acrid.[19]

Just as qi exists within the body, Chinese medicinal plants, foods (plants and animals), all have their own ascending or descending qi movements that correspond to Zang (脏) organs. This is established in the TCM concept that everything is related to the five elements. When understood according to the law of the five elements, all foods have the characteristics of wood, fire, earth, metal, and water. Therefore, the preservation of health through the five-grain diet also follows the attributes and laws of the five elements to benefit the liver, heart, spleen, lungs, and kidneys, so as to nourish the corresponding Zang organs. For example, the qi of a certain grain type is described as flowing to its corresponding Zang organ: rice's qi flows to the spleen, sesame's qi flows to the liver, wheat's qi flows to the heart, beans or legumes' qi flows to the kidney, and millet's qi flows to the lungs [Table 5]. According the theory of TCM, the spleen is responsible for transportation and transformation, in which a food substance is transformed, absorbed, and distributed in the body. While TCM refers the kidneys as the origin of “congenital constitution”, the spleen is the source of “acquired constitution,” meaning the food we eat is the base for substance transformations. However, as each food has its own qi direction, overconsuming or favoring one food may disturb the spleen qi for food is best prepared in combination to countercheck opposing properties to avoid overspending the spleen qi and disturbing the body's balance. Applying the concept “grain of nourishment” also means balancing the yin and yang of the body by taking advantage of a food's directional characteristics.
Table 5: Five elements theory of food and zang

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Some recent discoveries in the nutritional sciences have suggested consciously incorporating various whole grains into the daily diet could provide complete nutrient intake rather than consuming one single grain. For example, amino acids, which differ between whole grains and legumes, complement each other when consumed. Proper cooking techniques can also enhance nutrient intake. For example, researchers have found that the fat-soluble carotenoid in tomatoes can be increased by simmering in olive oil, thereby increasing the content and bioavailability of phytonutrients.[27] Unfortunately, diversifying plant foods may be difficult right now, as there is a big problem in the under-utilization of food species in the current food production system, and loss in agro-biodiversity is linked to poor overall dietary health. Currently, only about 200 out of 14,000 plant species are used in global food production; rice, maize, and wheat together can contribute up to 60% of the calories consumed.[1] Diversifying food intake is important for maintaining our planet's biodiversity and ecosystem and contributes greatly to human nutritional quality, health protection, and multisensory flavors [Figure 2].
Figure 2: Example of a plant-based traditional Chinese medicine cuisine interpreted for the globalized diet, made from Sha Shen Mai Dong Decoction (沙参麦冬汤) and served with Fu Ling (茯苓 Poria) Gnocchi

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  Conclusions Top


Advancement in nutritional science has presented us with challenges in a globalized context. The implementation of a universal dietary pattern protecting biodiversity must not only provide dietary guidance for the individual but also for sustainable development and globalized nutrition. The plant-based diet has recently been promoted as the better dietary structure for overall health. Studies have indicated that plant-based diets lower the overall mortality in comparison to the regular consumption of meat. It is also associated with lowering the risk of NCDs. The World Health Organization believes that every human being has the fundamental human right to adequate food and nutrition. In order to ensure that we all have a healthy diet now and into the future, we must commit ourselves to a healthier and diversified plant-based diet that is also sustainable for food production system. If this cannot be realized on all social and economic levels, not only will public health be negatively impacted, but also the irrational use of resources would prevent the UN sustainable development goals and Paris agreement from being achieved, and our next generation will soon inherit a severely damaged planet, where more of the world's population will suffer from malnutrition and preventable diseases.

Funding

This study was financed by grants from the Industry University Research Transverse Scientific Research Project Fund (No. CXY2020040103) and Shanghai University Municipal Key Curriculum Project.

Authors' contributions

Yin-Chen Chang conceived the presented idea. Hong-Yi Shen developed the theory. Hong-Yi Shen and Qi Xu verified the analytical methods. Xia Liu and Jia-Zhen Wu analyzed the diet and energy contributions and the interpretation of results. Yin-Chen Chang drafted manuscript preparation with Qi Xu. All authors discussed the results and contributed to the final manuscript. Hong-Yi Shen was in charge of overall direction and planning.

Ethical approval

The authors have no ethical conflicts to disclose.

Conflicts of interest

None.



 
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