Tibet

1. Tibet The land of Shangri-La Sarah Chorn

2. Overview Geography Government Staple Foods Meal Patterns Diet analysis Holidays & Festivals Health Issues Health Practices Communication Conclusion

3. Geography • Roughly 14,800 feet above sea level • Approximately the size of Western Europe • Mountainous, covered with grass & wet lands • High altitude makes farming almost impossible • Most Tibetans are nomads, pastoralists or specialize in animal husbandry • Language & religion is consistent between regions. (Foggin et al., 2006), (Miller, 1999)

4. Government • Dalai Lama is the spiritual and temporal leader of the Tibetan people • Currently the Tibetan government is fully functional, in exile, in Dharamsala India.

5. Staple Foods • Due to Tibet’s high altitude, food choices are minimal. • Traditional diet consists mostly of meat with little to no vegetables • Staple foods: yak meat, mutton, barley flour, cheese, yak butter tea • Tsampa– traditional Tibetan dish made from toasted flour, milk, sugar and sometimes tea and eaten at every meal. • Momos – Tibetan dumplings with meat in the middle • Chura – Dried cheese • Tsilu – Dried meat (Bera, 2004), (Kittler, 2008)

6. Yak Butter Tea (Po Cha) • Butter tea is a huge part of the Tibetan culture • Average Tibetans drink it 20-30 times/day • Rejecting butter tea is seen as an insult • Westerners often describe it as tasting “rancid” • Butter tea consists of: • Yak, sheep or cow milk called “crispy oil” • Black tea • Salt • Butter (kittler, 2008), (Bera, 2004)

7. Meal Patterns • Traditionally Tibetans eat 3 meals a day: • The first meal is eaten mid morning • Tsampa soup, hot butter tea and dried cheese (chura) • The second meal of the day is eaten around noon • This meal is the major meal of the day – families gather together • Rice, potatoes, onions, garlic, leek and possibly dried meat (tislu), tsampa and butter tea • Dinner is in the evening and is usually light • Dinner usually consists of tsampa and butter tea • Those with more income, living in lower altitudes will have more vegetables in their diet. (Bera, 2004)

8. Food & Religion • Religion plays a big role in the foods Tibetans eat. • Buddha taught that all life is sacred. Therefore, they will not kill their own animals or have someone kill an animal for them. • Tibetans prefer to eat large animals and will almost never eat a small one. • They do not eat rabbit, chicken or fish • Nomads & people who do not frequent cities believe it is okay to kill large animals as long as the whole animal is used. • Tibetans eat older animals, as killing an animal full of life is a negative action. (Miller, 1999), (Bera, 2004)

9. Diet Analysis • Woman, 25 years old, 126 pounds, 5 foot tall • Midmorning Meal: • Tsampa, butter tea, dried cheese • Afternoon Meal: • Tsampa, white rice, carrots, onion, garlic, dried meat, butter tea • Evening Meal: • Tsampa, yogurt, dried beef, butter tea • Total of 25 cups of butter tea throughout the day.

10. Diet Analysis Results • Estimates: • 2266 calories • 50-88 g fat • Actual Intake: • 7133 calories • 728 g fat • 657% of cholesterol • 127% protein • Nutrient Over Consumption • Essential Fatty Acids • Riboflavin • Vitamin B12 • Folate • Vitamin D • Vitamin A (1550%) • Vitamin E • Calcium • Magnesium • Zinc • Sodium (1210%) • Nutrient Under Consumption • Fiber (22%) • Niacin • Vitamin B6 • Vitamin C • Vitamin E • Iron • Potassium Diet Analysis Plus

11. Diet Analysis Charts Vitamin Breakdown Fat Breakdown Mineral Breakdown Diet Analysis Plus

12. Holidays & Festivals • Holidays fall on the Tibetan lunar calendar • Celebrate more holidays than any ethnic group in Asia • Losar: Tibetan New Year • Usually falls in February or March • Celebrated the 1st-3rd days of the month • Fill baskets full of wheat, ginseng, barley, barley ears, colored flowers made out of butter • Bring these baskets to their neighbors and say “TashiDelek” or “good luck” • After they deliver the baskets they feast and drink in the new year • Saga Dawa(Festival to Free Captive Animals) • Religious Holiday • Celebrated on the 4th month • Monks stay in monasteries, reciting scriptures and praying • Refrain from eating meat • Celebrates the birth of Buddha and the day he gained enlightenment (China Tibet Tourism Bureau, 2007).

13. Holidays & Festivals Cont. • Butter Lamp Festival • 15th day of the first month • Monks make lamps and sculptures out of butter • Light them at night in front of temples and monasteries • It is a night of merry-making. • Holiday Foods: • Chhang – home brewed rice & barley beer • Drank by women • Important for weddings and festivals • The success of the festival is determined by the chhang that is served. • Betel Nut • Given as a gesture of good will • Also given to guests as a greeting (China Tibet Tourism Bureau, 2007), (Bera, 2004)

14. Health Paradox • Altitude and lack of vegetation & diets composed mainly of protein and saturated fats give Tibetans elevated risk for CVD, high blood pressure and cholesterol. • Although Tibetans have increased risk, they tend to have remarkably low levels of all these health issues. • Why is this? (Owens, 2002), (Bera, 2004)

15. Health Paradox: Answered • High altitude is believed to play a role in lower cholesterol levels. • Massive consumption of Barley and teas impact risk factors. • Barley contains soluble fiber • Teas contain antioxidants • Food is medicine • Foods are not only for sustenance but also to provide health and wellness. • Many spices Tibetans use have powerful antioxidant properties • Seasonal fat storage. • Tibetans accumulate fat during winter months & shed it during active summer months • Many Tibetans who have fled to other countries have been forced to change their lifestyle. For those Tibetans obesity is an issue. (Owens, 2002), (Bera, 2004)

16. Health Practices & World View • Tibetan medicine is a mixture of different medical traditions from neighboring countries. • Tibet’s isolated region provides us with one of the oldest, and most unchanged medical traditions • Common forms are acupuncture, herbal pharmacology, meditation, yoga • Parts are dated back to the 6th century B.C.E & have been revealed in scripture • Body is seen has having 4 levels and multiple energy points • Each energy point is connected to one of the five earth elements • Health is seen as homeostasis between inner and outer elements (Loizzo, 1998), (Huber, 2002)

17. Health Practices & Worldview Cont. • Tibetans look beyond general causes of disease and also analyze lifestyle & habits • Primary causes of disease or infection would be obsessive, compulsive and addictive behavior patterns. • Every object in their world, including nature has equal importance - stress interconnectedness • Cited as the only current & ancient tradition that has actually achieved human-environmental balance. • This view is so important it is hard to tell where religion ends & environmental protection begins. (Loizzo, 1998), (Huber, 2002)

18. Communication • High context culture • Rely heavily on family, therefore health issues will be discussed with family before a treatment is decided upon. • Traditionally a Tibetan will be evaluated physically and mentally before determination on disease or infection is reached. • Most treatments should address lifestyle and symptoms together (Bera, 2004), (Huber, 2002)

19. Communication & Food • When counseling a Tibetan, remember their food beliefs: • Drinking warm butter tea is believed to keep individuals warm • Tea is also believed to help digestion • Consuming butter products is believed to help keep individuals fight the cold climate and help prevent infections. (Bera, 2004)

20. Conclusion • Traditions are ancient and roughly unchanged. • Believe in a multi faceted view of health which dates back centuries and is roughly unchanged. • With diets composed mostly of protein and fats, Tibetans have learned to use cardio protective agents found naturally in their environment to help prevent against CVD, high blood pressure and high cholesterol. • Live in peace and harmony with their environment • Their lives center around their religion

21. References Kittler, P.G., & Sucher, K.P., (2008). Food and Culture (5th ed.). California: Thomas Wadsworth. Foggin, P., Torrance, M., Dorje, D., Xuri,W., Foggin, J. (2006, November). Assessment of the Health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of The Tibetan plateau. Social Science & Medicine, 63(9), 2512-2532. Retrieved September 19,2008, from CINAHL database. Bera, Sanjukta (2004). Food and Nutrition of the Tibetan Woman in India. Anthropologist, 6(3), 175-180. Retrieved October 15, 2008, from Google Scholar. China Tibet Tourism Bureau (2007). Festivals in Lhasa. Retrieved October 16, 2008, from http://www.xzta.gov.cn/yww/Introduction/Festival/4887.shtml. Owen, P., & Johns, T. (2002, August). Antioxidants in Medicines and Spices as Cardioprotective Agents in Tibetan Highlanders. Pharmaceutical Biology, 40(5), 346. Retrieved September 19, 2008, from Alt HealthWatch database. Loizzo, Joseph J., Blackhall, Leslie J., (1998). Traditional Alternatives as Complementary Sciences: The Case of Indo-Tibetan Medicine. The Journal of Alternative and Complementary Medicine, 4(3). Retrieved October 16, 2008 from Google Scholar. Huber, T., & Pedersen, P. (1997, September). Meteorological knowledge and environmental Ideas in… Journal of the Royal Anthropological Institute, 3(3), 577. Retrieved September 19, 2008, from Academic Search Premier database. Dang, S., Yan, H., Yamamoto, S., Wang, X., & Zeng, L. (2005, September). Feeding Practice Among Younger Tibetan children living at high altitudes. European Journal of Clinical Nutrition, 59(9), 1022-1029. Retrieved September 19, 2008, doi: 10.1038/sj.ejcn.1602207 Miller, D.J. (February, 1999). Nomads of the Tibetan Plateau Rangelands in Western China Part Two: Pastoral Production Practices. Rangelands, Vol. 21, No. 1 (Feb., 1999), pp. 16-19. Retrieved: September 19, 2008 from JSTOR database.