How to Control Diabetes and Diet? By Dr V Mohan, Chairman, and Chief Diabetologist
Diabetes mellitus
affects the metabolism of carbohydrates, protein, fat, water and electrolytes.
Treating a disease with the food you eat is one of the most important aspects
of caring for people with diabetes. For individuals with type 2 diabetes, dietary management
is the initial and most important step to treat the disease. For individuals
with types 1 and 2 diabetes, food intake is an integral part of medication
decisions. The nutritional needs of every individual vary with the individual
differences in physical patterns, lifestyle habits and personal likes and
dislikes, and many others. Therefore, individual nutritional needs should be
personalized, taking into the consideration personal variables like a person's
age, activity level, current weight and body style, individual food habits and
the family diet pattern, cultural preferences and lifestyle.
Earlier diets for diabetic individuals
consisted of very low carbohydrate content. This has changed in the past few
decades, where the carbohydrate content of the diet has been increased to 60 %
with a reduction in fat content to 30%. Traditional staple foods, eaten in the
past with less refined grains such as hand pounded rice which was high in
dietary fiber have been replaced by
highly refined carbohydrates such as polished white rice. This nutrition
transition has resulted in a major increase in our calorie load from there fine
carbohydrates and a consequent increase in blood glucose levels of the
population. Such foods that can rapidly increase the blood glucose levels in
our body are known as foods with a high glycemic index (GI) and our
supermarkets today are flooded with such foods, thus hastening the diabetes
epidemic.
In our populations, where we habitually consume high-carbohydrate diets, the increased intake of high GI foods such as refined grains (maida, Rava) or white rice has been associated with insulin resistance and type 2 diabetes. Similarly, our research findings have also indicated that intake of more refined carbohydrates and less dietary fiber results in low HDL – C (good cholesterol) concentrations among Asian Indians and thus lead to the higher prevalence of metabolic syndrome.
Along with the quality of carbohydrates, the
quality of fat in the diet is equally important. A recent diet survey in
Chennai carried out by our Institution showed that high consumption of
sunflower oil lowers the HDL (good cholesterol) concentrations. Sunflower oil
is rich in PUFA (Polyunsaturated fatty acids) and n6 fatty acids, while it is
deficient in n3 fatty acids. The consumption of fish which contributes to n 3
fatty acids in the diet is comparatively low in Chennai population which alters
the overall n6:n3 ratio in the diet and increases the risk of diabetic
complications such as cardiovascular diseases. It is essential to consume a
blend of oils rich in both MUFA (Monounsaturated fatty acids) and PUFA for the
prevention and treatment of diabetic complications.
Dietary recommendations for the management and
prevention of diabetes should, therefore,
focus both on the quality and quantity of carbohydrates and fat in the diet and
increasing dietary fiber, in addition to balancing total energy intake with
expenditure (through regular exercise). When a balanced diet provides optimum
nutrition, diabetic individuals usually do not need any additional supplements
of vitamins and minerals. Appropriate nutrition measures will help in reducing
the risk of not only diabetes but also hypertension, dyslipidemia, metabolic
syndrome, and obesity.
Primary goals of dietary management in
individuals with diabetes are to:
- attain desired blood glucose levels
- prevent or reduce the risk of complications of diabetes.
- achieve target lipid levels that reduce the risk of cardiovascular disease.
- control the blood pressure levels.
- reduce excess body weight
- personalize individual nutritional needs, taking into consideration the individuals food
- habits and the family diet pattern, cultural preferences and lifestyle.
- promote overall health through good nutrition (balanced diet) to enhance the quality of life.
How do we go about advising healthier diets?
The diet of urban South Indians today consists
mainly of refined cereals combined with low intake of fruits and vegetables
(265g/d) compared to the WHO /FAQ recommended intake of 400g/d to prevent
chronic diseases. A higher intake of fruit and vegetables explained 48% of the
protective effect against CVD risk factors. Intake of dietary salt in urban South
India was much higher (mean 8.5g/d) than currently recommended (<5g/d).
Increased salt intake is a known risk
for hypertension. This calls for urgent steps to decrease the salt
consumption of the population as a whole. This could help to prevent hypertension
and thus prevent strokes and heart attacks.
A regular dietary pattern
of Indians receives almost 60% calories from carbohydrates. It is unlikely that
the total carbohydrate content of Indians could be suddenly reduced. It is thus
prudent to encourage the introduction of low GI foods in the market as well as
to promote high-fiber foods among the public. Glycemic index being the property
of the food, could be widely influenced by various factors such as starch
structure, fiber content, cooking methods, degree of processing and presence or
absence of fat. For example, both the production and consumption of brown rice,
which also contains higher amounts of vitamin, minerals and phytonutrients,
should be encouraged through integrated community and national programmes of
the government.
A recent study from our centre has shown that
consumption of brown rice compared to white rice could improve 24-hour blood
glucose and meal insulin levels. The study also explored people's perceptions
and acceptability of brown rice as a staple food and sought to identify factors
that may act as barriers or promote their acceptance. People said that lack of
awareness about the nutritive properties brown rice was a major barrier to its
acceptance. Further, participants tended to consider cooked rice that was not
white or long-grained, to be 'inferior'. Thus, we concluded that it is feasible
to assure that adopting a diet that is rich in whole grains could be a
cost-effective, feasible and sustainable approach to diabetes prevention and
control in India.
In summary, appropriate dietary management of
diabetes includes a reduction in the total calorie intake from refined
carbohydrates and simple sugars modified fat both in quantity and quality,
increase complex carbohydrate and adequate dietary fibre consumption. Following
this diet pattern will help one to achieve good control of diabetes, prevent
complications, reduce drug requirement and maintain ideal body weight.
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