Know your diet in diabetes

Diet sheets as the “raddi” paper diet!

Diabetes Diet Chart are universally prescribed. It is recommended by scientific authorities to have a diet chart for every patient in accordance with weight and height [BMI].

It has been found that patients are definitely not interested with counting calories, going through exchange lists, fiber content of the foods, glycemic indices and relative merits of polyunsaturated content of the cooking oil.

Neither are they going to weigh and minutely measure all that they eat. Many patients consider these sort of diet sheets as the “raddi” paper diet! Either one has to carry along a weighing scale as most of the raddi paperwallas do and measure everything one eats or more frequently, the diet sheets end up as “raddi” paper as soon as the patients reaches home.

If one does take the diet sheets seriously and tries to follow them, this is often going to cause serious problem at home where the whole kitchen schedule will need to be changes but of course the diabetic diet principle cannot be changed to suit the home environment or so many doctors feel! Or worse still, such patients have been vividly described, the patient ends up being a bit neurotic! This is what has been perceived by many top diabetologist including Dr Sadikot.

What I tell my patients that you have to follow the normal traditional diet in moderation and avoiding sugar enriched substances. This concept works well.

Concepts in diet keep changing

Aggressive dietary interventions may reduce CVD events to a similar magnitude as that achieved with statins. Compared with medical or surgical interventions, nutritional intervention is low-risk, low-cost, and readily available.

Carbohydrates

Whole grain and legume consumption decreases blood sugar and insulin resistance and prevents the development of diabetes, particularly in people with the metabolic syndrome.

Whole-grain products are a good source of fiber, minerals, as well as several vitamins, including vitamins B and E.

A whole-grain food includes all the edible parts of the grain: the bran, the germ, and the endosperm.

Grinding or milling, using modern technology causes the loss of many beneficial micronutrients, antioxidants, minerals, phytochemicals, fiber, and much of the germ.

As a result, refined grain products are devoid of most vitamins and essential fatty acids, and contain more starch.

Because of the loss of bran and pulverization of the endosperm, refined grains are digested and absorbed rapidly, resulting in a large increase in the levels of blood sugar and insulin.

The common grains consumed: Wheat, oats, rye, rice, barley, and corn.

Commonly consumed refined grain foods include white rice (idli, dosa), refined wheat and flour (white bread), pancakes, cakes, sweet rolls, English muffins, muffins, waffles, rolls, biscuits, pizza, and refined-grain ready-to-eat breakfast cereal, and their use should be minimized

* Compared to fats and protein, carbohydrates have the greatest impact on blood sugar.
* Both the amount and type of carbohydrate affect blood glucose.
* Carbohydrate types are either complex (as in starches) or simple (as in fruits and sugars). One gram of carbohydrates equals four calories. The current general recommendation is that carbohydrates should provide between 40 – 65% of the daily caloric intake. Carbohydrate intake should not fall below 130 grams/day.
* Vegetables, fruits, whole grains, and beans are good sources of carbohydrates.
* Whole grain foods provide more nutritional value than pasta, white bread, and white potatoes.
* Brown rice is a better choice than white rice.
* Patients should try to consume a minimum of 20 – 35 grams of fiber daily (ideally 50 grams/day), from vegetables, fruits, whole grain cereals, breads, nuts and seeds.

Complex Carbohydrates

Complex carbohydrates found in whole grains and vegetables are preferred over carbohydrates found in starch-heavy foods, such as pastas, white-flour products, and potatoes. Most of these are high in fiber, which is important for health. Whole-grains specifically are extremely important for people with diabetes or at risk for it.

Simple Carbohydrates (Sugar)

Sugars are generally one of two types:

i. Sucrose (table sugar). Sucrose has been associated with higher triglycerides and harmful cholesterol levels.
ii. Fructose (sugar found in fruits). Fructose may produce a slower increase in blood sugar than sucrose, which may have some advantages for people with diabetes. Dark-colored fruits are rich in important vitamins and other nutrients, and studies continue to report their benefits for the heart and health in general. Other fruits, such as apples and grapes also have important beneficial food chemicals.

Sugar itself, either as sucrose or fructose, adds calories, increases blood glucose levels quickly, and provides no other nutrients.

Know About Glycemic Index and Glycemic Load

The Glycemic Index – The glycemic index helps determine which carbohydrate-containing food raise blood glucose levels more or less quickly after a meal. The index uses a scale of numbers for specific foods that reflect greatest to least delay in producing an increase in blood sugar after a meal. The lower the index number, the better the impact on glucose levels.

No one should use the glycemic index as a complete dietary guide, since it does not provide nutritional guidelines for all foods. It is simply an indication of how the metabolism will respond to certain carbohydrates.
What Is a Low-Glycemic-Index Diet?

The basic premise behind the low-glycemic-index diet is that all carbs are not created equal.Some cause big spikes in blood sugar and others have little impact on blood sugar levels.

Specifically, the glycemic index measures how much a 50-gram portion of a carbohydrate raises blood sugar levels compared to pure glucose, which has a glycemic index score of 100.

Typically, foods that score higher than 70 are considered high-glycemic-index (GI) foods; those that score 55 and under are considered low-GI foods.

Many highly refined foods, including white bread, corn flakes, and instant potatoes have high GI scores; unprocessed, high-fiber foods tend to have lower GI scores.

But it isn’t as simple as saying choose unprocessed high-fiber foods. That’s because:

i. Foods such as carrots and potatoes can either be high-GI or low-GI foods, depending on several factors, including how long they are stored and how they are cooked or processed.

ii. Pasta that is cooked al dente has a lower score than pasta that is cooked longer. Rice can range from a low of 55 to more than 100, depending on variety and cooking time. The same is true with potatoes. And the riper the fruit or vegetable, the higher the score.

iii. Research suggests that the GI response to a given food also varies from person to person and can even vary within the same person from day to day.

iv. Some highly processed foods like cola and even some candy bars score low. A Snicker’s bar, for example, has a GI score of about 55.

Protein

Protein intake in diabetes is complicated. Protein recommendations vary among experts and depend on various factors. These factors include whether a patient has type 1, type 2, or pre-diabetes. There are additional guidelines for patients who show signs of kidney damage (nephropathy).

In general, diabetes dietary guidelines recommend that proteins should provide 12 – 20% of total daily calories. This daily amount poses no risk to the kidney in people who do not have kidney disease. Protein is important for strong muscles and bone. Some experts recommend a higher proportion of protein (20 – 30%) for patients with pre- or type 2 diabetes. They think that eating more protein helps people feel more full and thus reduces overall calories. In addition, protein consumption helps the body maintain lean body mass during weight loss.

Because protein causes the kidneys to work harder, patients with diabetic nephropathy need to limit their intake of protein. A typical protein-restricted diet limits protein intake to no more than 10% of total daily calories. Patients with kidney damage also need to limit their intake of phosphorus, a mineral found in dairy products, beans, and nuts. Potassium restriction is often necessary as well.

One gram of protein contains 4 calories. Protein is commonly recommended as part of a bedtime snack to maintain normal blood sugar levels during the night, although studies are mixed over whether it adds any protective benefits against nighttime hypoglycemia. If it does, only small amounts (14 grams) may be needed to stabilize blood glucose levels.

Good sources of protein include fish, skinless chicken or turkey, nonfat or low-fat dairy products, soy (tofu), and legumes (kidney beans, black beans, chick peas, lentils).

Fish – a tasty way to prevent sudden death:

In a meta-analysis of 11 prospective studies involving 116 764 individuals, fish consumption was inversely related to CAD death. This report suggests that 40–60 g/day of fish consumption is optimal, and results in a 40%–60% risk reduction.

It is important to distinguish between lean and fatty fish for cardioprotection, because the content of n-3 PUFA is highest in fatty fish.

Fatty fish, such as mackerel, sardine, and salmon, are widely available and inexpensive.

Heating is associated with significant loss of n-3 PUFA. Frying fish is associated with an even greater loss of EPA and DHA, and may be particularly harmful if fried in SAFA

Fish is probably the best source of protein. Evidence suggests that eating moderate amounts of fish (twice a week) may improve triglyceride and help lower the risks for death from heart disease, dangerous heart rhythms, blood pressure, a tendency for blood clots, and the risk for stroke.

The most healthy fish are oily fish such as salmon, mackerel, or sardines, which are high in omega-3 fatty acids. Three capsules of fish oil (preferably as supplements of DHA-EPA) is about equivalent to eating one serving of fish.

Soy:

Soy is an excellent food. It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins. Soy proteins have more vitamins and minerals than meat or dairy proteins. They also contain polyunsaturated fats, which are better than the saturated fat found in meat. The best sources of soy protein are soy products (tofu, soy milk, soybeans). Soy sauce is not a good source. It contains only a trace amount of soy and is very high in sodium.

Meat and Poultry:

Lean cuts of meat are the best choice for heart health and diabetes control. Saturated fat in meat is the primary danger to the heart. The fat content of meat varies depending on the type and cut. For patients with diabetes, experts recommend choosing skinless chicken or turkey over red meat. (Fish is an even better choice.)

A common misconception is that dietary fat of any kind is fattening, while low-fat and high-protein diets have slimming properties.

It is absolutely vital that both physicians and the public understand that it is the excess calories and not diet composition that causes weight gain.

Some fat is essential for normal body function. Fats can have good or bad effects on health, depending on their chemistry. New research suggests that the type of fat is more important than the total amount of fat when it comes to reducing heart disease.

Current dietary guidelines for diabetes and heart health recommend that total fat be 25 – 35% of total daily calories. Monounsaturated fats (olive oil, canola oil, peanut oil, nuts, avocados) and omega-3 polyunsaturated fats (fish, flaxseed, walnuts) should be the first choice for fats. Omega-6 polyunsaturated fats (corn oil, safflower, oil, sunflower oil, soybean oil) are the second choice. Limit saturated fat to less than 7% of total daily calories. Limit trans-fats (margarine, commercial baked goods, snack and fried foods) to less than 1% of total calories.

All fats, good or bad, are high in calories compared to proteins and carbohydrates. In order to calculate daily fat intake, multiply the number of fat grams eaten by nine (1 fat gram is equal to 9 calories, whether it’s oil or fat) and divide by the number of total daily calories desired. One teaspoon of oil, butter, or other fats equals about 5 grams of fat. All fats, no matter what the source, add the same calories. The American Heart Association recommends that fats and oils have less than 2 grams of saturated fat per tablespoon.

Try to replace saturated fats and trans fatty acids with unsaturated fats from plant and fish oils. Omega-3 fatty acids, which are found in fish and plant sources, are a good source of unsaturated fats. Generally, two servings of fish per week provide a healthful amount of omega-3 fatty acids.

Healthy cooking oils:

Groundnut oil, coconut oil, soyabean oil, olive oil etc. are regularly used in cooking. What are the characteristics of these oils and what is science saying about them. Below we discuss these in detail.

Groundnut oil / peanut oil

These are the most commonly consumed oils in India, particularly in the rural areas. They contain heart-friendly MUFA that lower the levels of bad cholesterol in our body without lowering the levels of good cholesterol.

In the market, it is available in refined form as well as filtered form.

Although the filtered oils are nutritionally superior, they often contain toxic compounds or adulterants.

Olive oil

Although more expensive than other oils, olive oil has many health benefits. It has mono-unsaturated fat and is the preferred cooking oil in Mediterranean countries.

When buying olive oil, it is best to select the extra virgin variety. In order to get maximum benefits, olive oil should be used to prepare salad dressings, as a seasoning for soups, for sauteing vegetables or for grilling.

Soyabean oil

Relatively new oil in India, soyabean oil contains PUFA, particularly linoleic acid and alpha-linolenic acid (ALA) in the right balance, which are essential for human health.

Soyabean oil is suitable for all types of cooking methods except frying; PUFA gets oxidised at frying temperatures to form toxic compounds.

Mustard oil – Best scientifically proven cooking oil

This oil is traditionally used in West Bengal and is prized for its characteristic flavour (pungent and sharp). It is generally available as filtered oil; refined mustard oils are sold as vegetable oil. Mustard oil has a higher proportion of MUFA and is also a rich source of the PUFA. However, it also contains erucic acid, a fatty acid that has undesirable effects on health when consumed in large amounts.

Mustard oil is suitable for all types of cooking including frying, but should be used along with other cooking oils to reduce the erucic acid content. Mustard oil is sometimes adulterated with argemone oil, which is toxic. It is very difficult to tell when this kind of adulteration takes place.

Ricebran oil

It is a relatively new oil that is extracted from ricebran and is gaining popularity in Asian countries like Japan , Korea, China and India.It is the ideal cooking oil since has good stability (lthis mean that, like other MUFA oils, it does not decompose at high temperatures to form toxic compounds) and is suitable for deep-frying. Studies have shown that snacks prepared in rice bran oil absorb 12-25 per cent less oil than those prepared in groundnut oil.

Sunflower oil

It is a popular cooking oil available under many brand names. This oil is rich in PUFA, particularly linoleic acid that lowers the levels of both good and bad cholesterol. Hence, this oil cannot be used as the only cooking oil; it could also be used along with other cooking oils such as red palm oil or palmolein oil that are low in linoleic acid

Safflower/ kardi oil

Available in the market under the brand name of Saffola, it also contains PUFA in the form of linoleic acid. Like sunflower oil, this oil too should be used in combination with red palm oil or palmolein oil.

Palmolein oil

It contains MUFA and is low in linoleic acid, hence it is healthy to use in combination with other oils.

Coconut oil

Used as a cooking medium in the south Indian states and other Asian countries, there are many misconceptions regarding its use as a cooking medium. Coconut oil contains saturated fats that are different from those present in animal fats. Like other vegetable oils, coconut oil also does not contain cholesterol and hence can be safely consumed as part of a balanced diet, in combination with other cooking oils, particularly sunflower or safflower oils.

Bananas

It is true that bananas Have a relatively higher sugar content and therefore tendency to cause a rise in the blood glucose levels is that much more as compared to the other common fruits, Once the patients are told that they can eat this fruit, they want to know whether they should eat the green or yellow variety of bananas, The rationale behind this question is the feeling that the riper the banana the greater is the sweetness and consequently the greater is the rise in the blood glucose levels.

Mangoes

There is no denying the fact that mangoes are sweeter than many other fruits just as are fruits like custard apple (sitaphal) etc. In fact, If one goes by the glycemic indices of fruits, one would find that different fruits have differing capabilities about the amount of rise in the blood glucose values that they bring about. A slice of papaya is said to bring about a lesser rise in the blood glucose levels, as compared to an orange.

Mango fruit has a medium, or intermediate, GI of 50.

Australian researchers suggest that compounds isolated from mangoes may be helpful in protecting the body against metabolic disorders like diabetes and high cholesterol. Today it is considered that eating mangoes is no real problem. The fibre and complexity of the flesh must make up for the sugar content and reduce the absorption rate of glucose.

Artificial Sweeteners

Many artificial or low-calories sweeteners are available. Using these artificial sweeteners should not give dieters a license to increase their fat intake. Studies indicate that consuming some sugar is not a significant contributor to weight gain as long as the total caloric intake is under control. There is some public concern about chemicals used to produce many of these sweeteners and adverse effects in studies using rats. Natural low-calories sweeteners are available that may be more acceptable to many people.

Saccharin – Saccharin has been used for years but is not used as commonly now. Some studies found that large amounts of saccharin caused bladder cancer in rats. Although the rats were fed huge amounts that do not apply to human diets, some evidence suggests that people who have six or more servings of saccharin per day may have an increased risk.

Aspartame – Aspartame has come under scrutiny because of rare reports of neurologic disorders, including headaches or dizziness, associated with its use. People with phenylketonuria (PKU), a rare genetic condition, should not use it. Studies have not reported any serious health dangers, but some people may be sensitive to it.

Sucralose – Sucralose has no better aftertaste and works well in baking, unlike other artificial sweeteners. It is made from real sugar by replacing hydroxyl atoms with chlorine atoms. Some people are concerned because chlorinated molecules used in major industrial chemicals have been associated with cancer and birth defects. Over 100 studies have been conducted on sucralose over a 20-year period with no reports of such risks.

Acesulfame-potassium – It has been used in the US since 1988 with no reported adverse effects.

Neotame – Neotame is a synthetic variation of aspartame but was developed to avoid its side effects. The association with aspartame has raised some concerns. Studies to date have reported no effects that would cause alarm and it appears to be safe for general consumption.

D-tagatose – This reduced calorie sweetener is a novel low-calorie sweetener derived from lactose, which is found in dairy products and other foods. It may be specifically beneficial for people with type 2 diabetes and have additional benefits that aid the intestinal tract.

Alitame – is formed from amino acids. It has the potential to be used in all products that contain sugar, including baked goods.

Stevioside – This is a natural sweetener derived from a South American plant. It is available in health food stores. People with diabetes should avoid alcohol-based forms. It has not been rigorously tested.

Nuts : Unwanted Dilemma

A Wholesome Food and Powerhouse of Healthy Fats and Nutrients

Nuts are not generally recommended as snacks because of their high fat content. But it is a dilemma. Nuts, when consumed with a meal, will significantly reduce the post-prandial glucose excursion by slowing digestion. Recent studies show that almonds, pistachios, or peanuts, when eaten along with high glycemic index carbohydrates such as white bread or mashed potatoes, will reduce the post-prandial glucose area under the curve by approximately 30% to 50%. Importantly, nuts also decrease meal-induced oxidative protein damage because they lower post-prandial oxidative stress and additionally provide antioxidants .

Epidemiologic studies consistently indicate that consumption of nuts at least 5 times per week will reduce CAD and diabetes risks by 20% to 50%. Nuts are as effective as increasing physical activity and trimming calories to increase HDL levels. Adding 2 oz or 60 g of nuts to a diet is a delicious way to decrease the TC/HDL ratio and CAD risk. Nuts also improve insulin sensitivity and prevent diabetes. Nurses Health Study indicates -frequent nut consumption is associated with a reduced risk of developing diabetes and cardiovascular disease.

* Randomized controlled trials of patients with type 2 diabetes have confirmed the beneficial effects of nuts on blood lipids also seen in nondiabetic subjects, but the trials have not reported improvement in A1c or other glycated proteins.

* Acute feeding studies, however, have demonstrated the ability of nuts, when eaten with carbohydrate (bread), to depress postprandial glycemia.

* Furthermore, there was evidence of reduced postprandial oxidative stress associated with nut consumption.

Although nuts contain 45%–80% fat, most of the fats are the highly beneficial MUFA and PUFA.

Almonds are a nutritional powerhouse, a natural source of most of the rare nutrients the human body needs for optimal health. Nuts, when consumed with a meal, will significantly reduce the post-prandial glucose excursion by slowing digestion.

Recent studies show that almonds, pistachios, or peanuts, when eaten along with high glycemic index carbohydrates such as white bread or mashed potatoes, will reduce the post-prandial glucose area under the curve by approximately 30% to 50%.

Importantly, nuts also decrease meal-induced oxidative protein damage because they lower post-prandial oxidative stress and additionally provide antioxidants. Epidemiologic studies consistently indicate that consumption of nuts at least 5 times per week will reduce CAD and diabetes risks by 20% to 50%.

Cashew nuts, like all nuts, are an excellent source of protein and fiber. They are rich in mono-unsaturated fat which may help protect the heart. Cashew nuts are also a good source of potassium, B vitamins and folate. They contain useful amounts of magnesium, phosphorous, selenium and copper.

Walnuts are unique because they are rich in n-6 (linoleate) and n-3 (linolenate) polyunsaturated fatty acids.

* A low lysine:arginine ratio and high levels of arginine, folate, fiber, tannins, and polyphenols.

* Clinical dietary intervention studies show that walnut consumption does not cause a net gain in body weight when eaten as a replacement food.

* Five controlled, peer-reviewed, human clinical walnut intervention trials consistently demonstrated walnuts as part of a heart-healthy diet, lower blood cholesterol concentrations.

* These results were supported by several large prospective observational studies in humans.