Diabetes and hypertension in Bhutan

For some years now, I have been wondering why there is a surge in diabetes and hypertension cases in Bhutan. The conventional wisdom, and that’s what the doctors say, is that people need to move and exercise more. While sedentary lifestyle brought about by greater mobility, TV and 3G contributes to the problem, it does not explain why farmers are also grappling with these same health issues. During my time in Sherubtse I carried around one Omron BP monitor and a thermometer (I needed them for myself, actually) and I did some random measurements and found incidences of hypertension in almost all the villages I did my “research”. I am not a medical doctor and so I didn’t prescribe any medicines. But my relatives were very impressed with me. They thought I had mastered even medicines besides engineering.

Blackened pots are rare sight in Bhutan now

Jokes aside, I have given a lot of thoughts on this and have browsed through several articles and scientific papers. Here are the three major possible causes. These are, obviously, in addition to what the doctors always tell us. These hypotheses are also supplemented by my own anecdotal evidences. I wish I could do a systematic and longitudinal study and collaborate with some medical professionals to make more conclusive claims. However, in Bhutan, research culture is nonexistent or badly under-resourced. In some cases, it is also frowned upon. Hence, to highlight the issue this article should suffice.

  1. Rice cooker

The traditional Bhutanese style of cooking rice involved throwing away the starch. In my family, we fed it to the dogs and used it to pre-dye the threads before weaving. Rice is 92% starch and 8% fibre. Starch, like sugar, turns into glucose in the blood stream and thus the consumption of starchy food can elevate your blood sugar levels. In the early 1980s, Hawkins pressure cooker hit the Bhutanese market and soon after Japanese rice cookers followed. Now Chinese cookers have reached wherever the Bhutan Power Corporation has taken the electricity to. In other words, at least in 95% of the country. The traditional way has almost disappeared because it is more convenient to use the electric cookers. However, when using them, the starch in the rice remains intact. Rice prepared this way is tastier but less healthy. Rice itself is not unhealthy but the cooking method, the amount we eat and the frequency of consumption make it very unhealthy.

Rice is a staple food in Asia. The Chinese, Japanese and Thai people also eat rice. However, they don’t eat the same quantity like the Bhutanese. They eat lots of noodles too. We, Bhutanese, are the only 100-percent-rice-eating-nationality in the world – by far the biggest rice-eaters per capita. We eat for breakfast, lunch, dinner and even as snacks (zow). When I was growing up in Tashigang, rice was only for special occasions. Except in western and southern Bhutan, east and central regions mainly consumed maize, buckwheat, wheat and millet. Now it is rice everywhere – and in every meal – not even every day.

  1. Doma

7tv6si2wjhseWhat is known as doma is composed of three ingredients – betel leaf, areca nut and slaked lime. Besides the known fact that betel nuts are carcinogen (causing oral cancer) while lime erodes stomach linings (leading to gastritis, ulcer and stomach cancer), eating doma causes taste buds to become progressively insensitive. This makes one to add more salt or sugar to feel the taste of the food.

  1. Geography – altitude

A study in the US was done to see if altitude changed our taste sensory. The research studied a group of participants at 3,500 meters above sea level for a period of three weeks. The subjects were asked to rate four compounds representing sweet, salty, sour and bitter taste over the period.

The result? An increase in the taste thresholds for glucose (sugar) and sodium chloride (salt). In other words, the participant felt that the same amount of salt and sugar they consumed at sea level was not adequate anymore. In fact, that’s the reason why airline food tastes bad, which also explains why cabin food comes with additional packets of salt, sugar and pepper. You would have noticed that if you live in Thimphu or Paro and you descend to Phuntsholing or Bangkok (lower altitude) you will find yourself hungry all the time. That’s because your taste buds work better and the increased oxygen at low altitude burns the food faster in your body.

What can you do?

Unfortunately, we can do nothing about the altitude but just know the fact that our body requires less salt and sugar than our taste buds ‘feel’ the need.

And then there are few things that are in our control.

I eat so little rice and my host said, “That’s like the amount we offer to deities”.
  1. Return to traditional cooking style. Remove the starch when cooking or throw away the rice cooker. It is an additional work but better than losing your health. Cook the traditional style. Otherwise, reduce rice consumption and replace with local choices such as khulay (buckwheat pancakes from Bumthang) roti (from Southern Bhutan) or mix rice with kharang (maize from Eastern Bhutan). Buy Bhutanese. It will be good for our farmers; it will help ensure our food security because bulk of rice we consume is imported; and you have reduced risk of being diabetic. I normally switch between rice, pasta and bread. When I was in Kanglung I ate lots of kharang. Make small changes. Take baby steps. Don’t jump from rice to kharang in one day. Your body will go mad.
  2. Be careful with salt. Salt is cheap and
    Japanese meal. Notice the rice portions and compare this with above picture

    easily available nowadays. When I was growing up, salt was in very limited supply (we rationed it very carefully). Besides, refined sugar or candies were totally unknown. Thais, Japanese and Chinese people hardly use salt in their cuisines – preferring soya sauce instead. Not to be culturally insensitive, but our suja is, health-wise, one of the worst drinks our forefathers invented. It is a bomb. It has saturated fat (butter), lots of salt (which saturates the butter even more) and an unknown and imported “tea” that comes mixed with baking soda (not sure of this chemical components either).

  3. Stop eating doma. Your taste buds will return to normal and food will taste better. And the town will be lot cleaner too. Forget the pact with Guru Rimpoche. That’s a myth.

(PS: The reference links to some of the articles have been provided in the article)


Rice is not even eco-friendly – requiring lots of water to grow.


To meat or not to eat

To eat or not to eat meat is a personal question and not an ethical or religious issue. The government should be allowed to do its job – how best Bhutanese can access meat, rather than default the system while engaging in the hypocrisy.


I turned vegetarian a little over two years back. It was purely a personal decision – with no religion or health issues involved. Of course, there were encouragements from different quarters including a rimpoche-friend who advocates against eating meat. But let me share one good reason, perhaps, that made me take the final step.

While attending a Buddhist conference in Kathmandu, a panellist asked the audience, “Do you know what you are eating? Do you know where your food come from?” She was in the panel discussing about why Buddhists eat meat and why they shouldn’t. Now her question reminded me of some horrendous things I saw in slaughterhouses across the border – many years back. And really, back then it didn’t strike me anything. Maybe I was too naïve or too insensitive. But in recent years I have also heard more terrible stories of animal feeds being used in these farms. Now I am not saying that these are true stories. However, as the nutritionist said, do you really know what you are eating? Now, I wasn’t 100 percent sure about what the animal, I was eating, was fed with. Seriously. The food safety standard in our region is not that great.

Then there was also the fact that I was homing in to 50 and I felt that my body didn’t require meat anymore. I guess I have enough storage of essential vitamins like B12 that come from red meat. It does not leave our body like potassium or magnesium. We don’t run the risk of B12 deficiency easily. So I thought if I don’t need it why have some animals slaughtered, which brings me to the question of what Buddhism says about it.


From the few readings that I made, the confusion seems to have started off with the monks in Gautama Buddha’s sangha itself. They depended on the generosity of lay supporters as they went on their morning rounds for food alms. Obviously, they couldn’t dictate what people offered. In a predominantly Hindu India, people only refrained from eating beef but not other types of meat or fish. So the monks would face a simple choice – eat meat or starve. This dilemma became worse in the Tibetan highlands where no grass grows and where green vegetable is in short supply. Furthermore, Mahayana and Vajarayana Buddhism are less dogmatic than Theravada and leave this critical decision to personal choices that you can make based on your sampa (true intention). So if the intention is to survive, it is OK. But if the kill is for greed, anger or jealousy, it is not ok anymore.

Going back to Buddha, what do the scriptures say? A line from Dhammapada V 130 reads,

“All tremble at the rod. All hold their life dear. Drawing the parallel to yourself, Neither kill nor get others to kill.”

Since Buddhism encourages interpretations here are some. First, we should refrain from intentional acts of killing, but it not necessarily from the consumption of animals that are already dead. Secondly, we should not intentionally ask someone to kill for us as in, for example, make a bjob to kill a yak for us. But we cannot prevent anyone from killing either because that may be his or her traditional lifestyle or the main economic activity to feed the family or send children to school – or both. We need to be realistic too and not just religious or idealistic.

In conclusion, what should we do (as Buddhist, if I may say)? Well, just as people adopted to eating meat for practical reasons to stay alive, if one could that by staying away from meat, then just do it. And do some readings, talk to doctors, get your vitamin level tested. If you are not a toddler and you are in pretty good shape, chances are that you don’t require meat at all. And take small steps. I stopped eating pork and then after a month I stopped beef and few months later, chicken. Don’t be over ambitious.

By the way, I am the only one in my family who stopped eating meat. I still eat fish and eggs. As said, I have not been coerced by anyone to stop meat nor would I force anyone to do that either. The choice should be personal and should come from within – from our sampa. Only then it sustains.



My life in 50 pictures – Part I

50 years is a great target for my generation. When we were growing up in the 70s we were given the country’s fact-sheet where our life expectancy was a miserable 35 years. So I remember praying to Buddha for a life way past that age.

So my generation has already lived 15 years more than what we “expected”. I achieved that on February 14, 2017 – on the so-called Valentines Day. In addition to the milestone of outliving the official life expectancy, I present here, in a five-part series, my life’s ups and downs in 50 pictures.

Part I : Early years and schooling

1967. Tongling. Radhi (Trashigang)


I was born in a hut above this village. My family was driven out from our ancestral home in Tongling. This place is called Drung Gonpa. Drung as in Drungpa (sub-district governor) and gonpa means temple. There is a temple there, which was founded by my maternal great-great-grandfather, the Tongling drungpa, in the early 20th century. People called it Drungpa Gonpa because it belonged to him. I grew up with my grandfather, Khandola, who was a hereditary lay-lama, my great-grandmother, whom we addressed as Ashi, my mother and my elder sister. My father was away in a distant place and I rarely saw him. I later learnt that he was drafted into the army following the border clashes between India and China of 1962. So my grandfather took charge of me and I grew up as a young novice – learning how to make ritual cakes – hoping to one day succeed him as a lama. I grew up drinking goat milk and walking with grandpa to the villages of Chaling, Radhi, Khardung, Tshenkar, Jonla where he was invited to conduct rituals and religious sermons. He rarely accepted the gaybcha (offering to monks for the service). I don’t remember his reasoning.


1972. Phuntsholing. Earliest photographic record.


When I was 5, my grandfather passed away. So my hereditary duty to become a lama also died with him. My father, who was working in Bhutan Government Transport Service (BGTS) as a driver, came to back to the village and took me to Phuntsholing.

There, he enrolled me in Phuntsholing Primary School in class Infant ‘C’. I aced the class that year. I and an Indian boy, whose father sold Murphy radios in Phuntsholing, were given double promotion. We were directly moved up to Infant ‘A’. In those days it was normal for good students to skip grades. The government was in a hurry to get students out of school and fill the newly established civil service. We were  basically fast forwarded to the job market. (How times have changed….)


1974. Loyal Studio, Phuntsholing. (Photo. To my right is my father. To my left my uncle)

don-bosco-boys-ii-001Two years later I moved to Don Bosco Technical School in Kharbandi. My father rarely was home (he went on driving duty) and my mother had to be in Tongling to nurse my great-grandma. So I was packed off to a boarding school. I was only 7 and I remember Father Philip, the Selesian principal, refused to take me in. So my father, who had earlier worked as a royal chauffeur, got a kasho (royal edict) from HRH Ashi Dechen Wangmo Wangchuck (a real angel for many Bhutanese of my generation). The trip to Thimphu also coincided with the Coronation of the Fourth King Jigme Singye Wangchuck. At the celebration ground in Changlingmithang, I received my largest sum of money until then, Nu. 5, which lasted for good 3 months. On my return journey from Thimphu all I can remember is taking a detour to Dawakha over a scary Baily bridge over Chuzom – and vomiting all the way to Phuntsholing in his white BGTS International truck that had the map of Australia on the door (I would later learn that those American International trucks were a gift under the Colombo Plan. They were such powerful beasts).


1980. Kharbandi, Phuntsholing (Siting, L-R – Thinley Dorji (CEO of Dagachu/Kurichu Power, Ugyen, me (always smiling), Ugyen Tashi. Standing L-R: Late Kesang Ragu (engineer, BBS), Brother Joy, Tenzin, Sonam Phuntsho (engineer, Bhutan Telecom), Brother Areng)

Don Bosco Technical School was renamed as Kharbandi Technical School. Go Go hairstyle was the fashion and Levis blue jeans was our dream but we were all barefoot (see picture). I was 13. I was a good student but I was naughty and I rarely studied. I would be all over the place. Still, I loved science, history and geography and was a champ in general knowledge (GK). On the vocational side, I did carpentry, welding, plumbing and was majoring as an electrical technician (I still do all the carpentry and electrical works at home). I loved sports too but was fat and unfit to be really good at anything. More than that it was perhaps because I had a hobby – almost an addiction – movies. Dharmendra and Clint Eastwood were my favorite stars. I never missed any movie in Norgay Cinema and so I found myself slipping out of the dorm regularly at night – braving darkness, snakes, scorpions and very vigilant dorm councillors. When I got caught I was reprimanded with toilet cleaning jobs and watering the trees (my early contribution to green Bhutan). I was also beaten very badly, at times. The Selesians were not angels. Corporal punishments were a norm. My father even encouraged them. (So much for all the controversies on the issues these days.)


1982 – Bhutan Photo Studio, Phuntsholing. (Photo: Front row: L-R. Kencho Tseten (Executive Engineer, His Majesty’s Secretariat), Nagphey Dukpa (Executive Engineer, Thimphu Thromde), Chencho Tshering (Joint Managing Director, Mangdechu). Standing: L-R. Thinley Wangchuk (Principal, Institute of Zorig Chusum, Tashi Yangtse), Kado Rinzin (Businessman, Gelephu), Yours Truly (in white pants, white shirt inspired by Bollywood star, Jitendra ☺)


Although the school and the government provided everything we needed in school, we were always broke with no pocket money to buy other stuff. I had one set of cloth that I could dress up to go to town. We went around in Bata slippers and played football barefoot – all the time. So my friends and I were so excited to receive our second pair of canvas shoe on the eve of the annual sports day that we decided to take a photo. By the way, taking photo in a studio was also very expensive. That year I was also about to finish my matriculation (that was a term for school leaving certificate exam), which was one of the highest qualifications someone received in those years. Can you imagine the excitement in my family? It was as if I was getting the Nobel Prize. When I matriculated few months later, my father also bought me something I was nagging for years – leather top boot and Levis jeans pant. He paid a hefty sum of Nu. 50 just for the shoe. His salary was Nu. 150. (Today I never refuse anything that he asks. He sacrificed a lot for us.)
1982 – Phuntsholing, Study tour to BGTS Workshop.
Don Bosco boysIV - Version 7
In December 1982 I completed my matriculation. But as we were about to set off for the 14-day study tour to India (those days we had such privileges too) a bolt from the blue struck me. My paternal uncle, who was an engineer and whose education my father sponsored, and who was planning to reciprocate by sending me for pre-university (PU) studies to Shillong, was killed in an accident. I saw my life and dreams blown away in an instant. We were planning that I studied medicines and become a doctor. And there was no way that my father with his salary of a truck driver could afford to send me to Shillong. We were not accepted in Sherubtse because our school followed the Megalaya Board of Exams. During the entire 14-day trip to India where we visited Calcutta, Jamshedpur and Ranchi I cried almost every night. It was double blow. I lost my dearest uncle and I also saw my dreams fade away. Not being able to do PU also meant that I would never go to a university. I felt lost – completely thrown off from my path. I was just 15. Yes, life dealt me with a devastating blow at a very young age.
Dewathang gate. Photo: Gupta Studio, SJ
1983. Dewathang, Samdrup Jongkhar
After our India trip, we went to Thimphu where we had to report to the Manpower Directorate (that had just been renamed as the Royal Civil Service Commission) to take up jobs in the government. I was barely 16 and I wanted to continue my studies. Since Sherubtse was not possible the next best option was to head for Dewathang to study at the Royal Bhutan Polytechnic and become an engineer.
Life will often present you with a wall. If you cannot climb over it, don’t keep banging your head. Take a detour.
But at the Directorate of Manpower, a long stand-off with the employment officer (very cruel guy) began. I persisted and endured one week of Thimphu’s cold and hunger till a divine hand intervened. I was allowed to go to Dewathang. After borrowing Nu. 50 from a cousin I headed to the East. From that on, I never looked back.