Diet and Diabetes

Importance of Diet in Diabetes
Diet is an integral part of diabetes care and management. Food selection, preparation, portion size, timing of food consumption, activity adjustments influence diabetes management and achievement of set targets and individual goals.

The main aim of diet therapy is to help People with Diabetes in making appropriate changes in their lifestyle both in their diet and exercise habits, which would lead to improved metabolic control. A well balanced and a nutritious diet helps in maintaining euglycemia by keeping blood glucose, lipids, blood pressure and body weight under control.

Persistent high blood glucose levels cause complications of diabetes. People with diabetes often have associated high blood pressure, associated heart disorders and lipid disorders, particularly increased serum triglyceride levels. Proper nutritional advice helps in the management of these associated conditions as well.

Many health organizations recommend that, to remain healthy people must consume whole grains, lean meat or fish, beans, eat at least 5 servings of fruits and vegetables per day, drink low fat milk and milk products and restrict total fat intake especially intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol in the diet. It is also important that the portion sizes should not be very large.
Major Nutrient Recommendations

Carbohydrates (CHO)– 1 gm of CHO = 4 Cals.
Carbohydrates should constitute around 60-65% of your total calories intake /day
Carbohydrates are the main source of energy. They break down into sugar in the blood, which your body stores it to use it later when it’s needed, however, when you have diabetes, you either do not produce insulin or are resistant to it. This results in a build up of excess blood glucose, the cause of diabetes. A minimum of 100 gms of carbohydrate is essensial to prevent ketosis or excess fat breakdown

Two main types of carbohydrates exist are Simple and Complex.
Simple Carbohydrate causes your blood glucose to escalate beyond healthy levels, Simple carbohydrates are known as quick-release carbs, they break down rapidly in your blood, which absorbs it immediately, causing your blood sugar to rise instantaneously. They are important during Hypoglycaemia to raise the blood glucose.
Sources of simple carbohydrates are – Glucose in sugar, honey , jaggery, Fructose in fruits, Lactose in milk

Complex carbohydrates helps to regulate both your glucose levels and calorie consumption.
They are just the opposite and contain a number of vitamins and nutrients your body requires. High in fiber, these carbs are slow-release because your body cannot digest them as easily; this results in slow absorption and less of an impact on your blood glucose levels. Foods in this category are also low in calories and give you a feeling of satiety.
Sources of complex carbohydrates are Cereals- wheat, rice, jowar, bajra, fruits and vegetables.

Dietary Fibre– Dietary fibre is the edible part of plants that are resistant to digestion and absorption in human small intestine with complete or partial fermentation in the large intestine. It is a type of complex carbohydrate. Fibre is basically of two types: insoluble and soluble.
Insoluble fibre – e.g. Cellulose, hemicellulose and lignin are non-starch polysaccharides ( NSP), which make up the principal structural material in the plant cell walls,.
Source– The main food source is stems and leaves of vegetables, whole grain cereals, i.e. seed and grain coverings, skins and hulls; and bran.
Advantages– They do not contribute to the nutritive value of foods the presence of fibre, i.e, roughage in the diet is necessary for the mechanism of digestion and elimination of waste. Roughage is necessary for normal bowel movement. It provides volume and bulk to stool and also maintains the healthy profile of bacteria in the bowel.

Soluble fibers -e.g. pectins, gums, ß-glucans, mucilages and major portions of hemicelluloses. form a gel with water and are present in the form of pectin, gums and mucilage, which are plant cell secretions.
Sources– The main food sources are isabgol, bran, oatmeal, vegetables, pulses-sprouts and fruits like apple, guava and citrus fruits.
Advantages– The have been shown to lower blood cholesterol in hypercholesterolemic subjects and blood glucose in diabetes. It delays digestion of food particles in stomach resulting in the delay in cholesterol absorption. It binds to bile salts and prevents its reabsorption resulting in a decrease in circulating levels of cholesterol. It removes bile acids and neural sterols by excretion through faeces. The soluble dietary fibres yields short chain fatty acids (SCFA) due to fermentation in the colon. The SCFA are carried to liver by bile circulation and inhibit cholesterol biosynthesis.
Disadvantages -The dietary fibres could also have some adverse effects on human nutrition by binding to trace minerals and preventing their absorption, in case of foods with marginal levels of trace minerals.
Suggested Intake: Intake of Total Dietary Fibre (TDF) should be 25-40 g/day or 12 g-14g TDF /1000 kcals energy.

Glycemic Index

The ability of a food item to raise the blood glucose is measured in terms of Glycemic index.
Glycaemic index is an in vivo measure of the relative impact of carbohydrate containing foods on blood glucose. A particular food’s glycaemic index is determined by evaluating the incremental rise in blood glucose after ingestion of a portion of the test food containing 50 g of carbohydrate, compared with the same amount of carbohydrate from a reference food, which is usually white bread or glucose.

Protein. : 1 gm of protein = 4 kcals
Proteins should constitute around 15-20% of your total calories intake/day Proteins are important constituent of tissues and cells of the body. They form the important component of muscle and other tissues and vital body fluid like blood.
Functions – proteins supply the body building material and make good the loss that occurs due to wear and tear. Proteins as antibodies help the body to defend against infections. The proteins in the form of enzymes and hormones are concerned with a wide range of vital metabolic process in the body.
The dietary proteins are broken down into amino acids and absorbed as such and these amino acid derived from the dietary proteins are used by the body for various functions.
Amino acids can be divided into two groups essential amino acids, which are not synthesized in the body and have to be provided in the diet. Non- essential amino acids are those which are synthesized in the body in the presence of nitrogen. Good vegetarian sources are milk and milk product, nuts, legumes (soyabean, rajma, barbati etc.) , pulses (Tur, urad, moong, masoor , dal etc) and non- vegetarian sources are egg, meat, mutton and fish.
The adult requirement of protein is about 0.8-1gram/kg of Ideal body weight. Protein requirements are greater for children, during pregnancy and lactation period and are altered during some state of diseases.
Fat : 1 gm of fat = 9kcals
Fats should provide about 20-25% of total calories intake /day.
Dietary fats are derived from both plant and animal sources and are classified as “Visible” or “Invisible” types. Fats that are used as such at the table or for cooking (vegetable oils) are termed “visible” fats. Fat that are present as an integral component of different of different foods are referred to as “Invisible” fat.

Health tips

  • Eat every 3-4 hrs, small frequent meals to avoid hypoglycemia.
  • Avoid fasting and feasting, watch the portion size you eat
  • Frequent monitoring is important to maintain euglycemia . The constant spikes, over a period of time, can lead to health complications such as kidney damage and failure, eye damage and nerve damage particularly in your feet and skin damage
  • Use multi grain flour: – Wheat Flour (3 kg), Barley/ oats (1/2 kg), Ragi(1/2 kg), Roasted gram/ whole gram(1/2 kg), Soya Flour (1/2 kg)
  • Limit the use of Salt in your daily diet. Avoid eating processed and packed foods, Pickles, Papad, Processed cheese, Namkeen, Biscuits and Bakery items, Packed soups & sauces.
  • Use 3-4 teaspoons of oil in an entire day cooking, Rotate oils every month (soyabean, sunflower, safflower, canola, rice bran, olive, Corn, groundnut, mustard etc)
  • Avoid Reheating of Oils and limit your fat intake
  • Use methods like Boiling, Roasting, Steaming, Poaching, grilling instead of frying etc.
  • Cut down on Trans fats provided by hydrogenated oil (Vanaspati ghee)used in many processed, bakery and fast food.
  • Avoid Alcohol and Smoking.
  • Have an early dinner before retiring for the night and have a glass/cup of low fat milk at least 2 hours after dinner as this helps to prevent hypoglycemia (low blood sugar levels) during the night.
  • Compliment your diet with a daily dose of exercise. Exercise is all about enabling one to live a healthy and disease free long life.