The ₹6,000 Food Budget of a Family of Five

Weakness 1 - too little iron, and little to help it be absorbed. The daughter's tiredness, breathlessness on stairs and pallor are typical of iron-deficiency anaemia, which is common in adolescent girls whose needs rise with growth and menstrual loss. Pulses only four days a week, no fruit and no lemon/amla mean low iron intake and low vitamin C, which is needed to convert plant iron into an absorbable form.

Weakness 2 - the diabetic husband eats exactly like everyone else. Large helpings of rice and potato, sugar in tea, and fried puris give a high glycaemic load with little fibre, which explains the 168 mg/dL fasting sugar. He needs the same healthy food in different proportions, not a separate expensive diet.

Changes within ₹6,000:

• Raise pulses to about 2 kg a month (roughly ₹200) and use them at every lunch; add a tablespoon of roasted chana or groundnut to the children's plates.
• Buy a lemon or guava two or three times a week (about ₹150 a month) and squeeze lemon on dal and green vegetables - this alone improves iron absorption from the same food.
• Stop sugar in the husband's tea and cut fried puris to once a week; the money saved on oil and sugar pays for the pulses and fruit.

Milk for the grandmother alone is not enough; 200 ml for each child is preferable to ghee in terms of nutrients per rupee.

The advice saves money in the short term but is wrong on three counts.

1. It removes the complementary protein. Cereals are low in lysine and pulses are low in methionine; eaten together (roti–dal, rice–rajma) they give a protein quality close to animal foods. Rice alone supplies protein, but of poorer quality, so the children and the pregnant-risk mother get less usable protein per rupee, not more.

2. It worsens the anaemia. Pulses are the cheapest everyday source of iron and folate in this kitchen. Replacing them with polished rice lowers iron intake and adds nothing that helps absorption.

3. It is harmful for the diabetic husband. More rice means more refined carbohydrate, a higher glycaemic load and less fibre - exactly what pushes fasting sugar up. Whole pulses, whole wheat and vegetables slow digestion and blunt the post-meal rise.

Pulses are not expensive per gram of protein: at about ₹100–120 per kg, 60 g of dry dal gives roughly 14 g of protein for ₹6–7, which no other protein food matches. The real saving lies in cutting oil, sugar and fried foods, not in deleting dal from the plate.

This is not a decision the mother should take alone, for four reasons:

• Anaemia has several causes. Iron deficiency is the commonest, but folate or vitamin B12 deficiency, worm infestation, thalassaemia trait and chronic infection also cause pallor and tiredness. Iron tablets help only the first; in thalassaemia trait they are useless and repeated unnecessary iron can be harmful.
• Dose depends on age and body weight. An adolescent needs a specific elemental iron dose, usually with folic acid, and the amount in an over-the-counter tonic is often too low to correct anaemia or too high to be safe.
• Side effects reduce compliance. Iron on an empty stomach causes nausea and black stools; a doctor or health worker can advise on timing, and on taking it with vitamin C rather than tea, which blocks absorption.
• Deworming may be needed first. If worms are present, iron is poorly absorbed until treatment is given.

The sensible route is to have the daughter examined at the nearest health centre or by the ANM/ASHA worker, get haemoglobin checked, and then continue iron–folic acid supplementation under advice. Meanwhile Meera can start the dietary changes at once, since they are safe and help whatever the cause.