What to eat to manage diabetes

By Parvathy R Krishnan

Historical perspective
Man and diabetes have come a long way – more than 2500 years. Sometime in the 600 BC Indian physicians Charak and Sushrut, both considered dietary management of diabetes or `madhumeha` as they called diabetes mellitus an important therapeutic approach. Diet manipulation has played an important role in diabetes management in antiquity Interestingly, both imposed major restrictions for stout diabetics and those with low physical activity. Charak insisted on weight reduction of overweight diabetics and Sushrut related diabetes to `gluttonous overindulgence`. They advised diabetics to eat more vegetables and coarse grains and less meat of domesticated animals and to avoid fats of animal origin. Twenty-five centuries later, we are in a new millenium and it is amazing that those advices of Charak hold true today as the basis of dietary management in diabetes. Western doctors are now appreciating and prescribing the high fibre, traditional diets of India and South East Asia. Diabetes is a disorder characterized by persistently elevated blood glucose levels. The clinical goal is therefore to achieve and maintain as near-normal blood glucose levels as possible, through diet, drugs and exercise.

The right diet
There is no single diet that can be applied to everybody. Prescribing a diet is highly individualized, depending on the age, weight, physical activity level, work timings, medication and life style. There has to be a balance between food intake and medication especially in the insulin dependant diabetic.

Sometimes, simply avoiding sugar by cutting out beverages, honey, jam, juices, soft drinks, desserts, chocolates, sweetened condensed milk or any other source of simple sugar is enough to bring down the blood glucose to normal limits. If you are normal weight and maintaining good glycemic control, about 25 grams of simple sugars is allowed in a day, as part of an otherwise healthy diet. This is equivalent to just one can of regular cola!

Complex carbohydrate
Legumes, whole grains, oats, barley, vegetables, certain fruits, broken wheat and pasta have low glycemic index. That means they raise the blood glucose slower than other kinds of foods. Interestingly, recent researches show that glucose levels are also affected by how quickly the food is eaten, how much is eaten at a time, the way the food is processed or cooked. So, eat smaller portions at each meal, with about 5 to 6 hours gap between the meals. Do not over cook vegetables and cereals. Whole grains (or coarse grains as Charak said), raw vegetables and fruits need longer chewing. So make this part of your meals. An over ripe fruit has more fructose and glucose in it. So choose fruits, which are just ripened.

If you are overweight, a modest reduction of 5 to 10 kilos can improve glucose levels, even without having reached the ideal body weight.

Soluble fibre
Gums, mucilage and pectin found in legumes, oats, whole grains, certain fruits and vegetables, condiments and spices helps in reducing cholesterol and post-prandial glucose. Unfortunately, many people view dals and beans, with suspicion. I suggest, eat less of rice, potatoes and flour, and more of pulses. Some examples are idli or dosa with sambar (not chutney), puri with chana (not potato sabji), puttu with chana (not banana).

Choose fruits like apple, orange, guava, amla, peaches, pears, papaya, plums, pomegranate, kiwi fruit, and strawberries.

Though not conclusive, there are speculations that chromium and zinc deficiencies effect in developing diabetes. Anyway, a diet rich in fibre will provide these in abundance.

It is best to avoid alcohol totally for several health reasons, but should you have a situation that calls for social drinking, then do not consume more than 2 drinks in a day. A drink would be a peg of hard liquor or a mug of beer. Those on medication should never drink on an empty stomach.

If your work calls for frequent travel, ask for low fat/diabetic meal on flight. Most reputed hotels also cater healthy meal options.

Life style changes
Diabetes does impose some changes in lifestyle and diet. It is these changes that create a big psychological impact. You could together with your dietician, note down the changes you have to make and the goals you need to achieve and work on them one at a time instead of trying to change over-night. Most of the guidelines are anyway those prescribed for the general public. Perhaps this is the time for the entire family to take note and start eating healthy.

Parvathy R Krishnan, a Nutrition & Dietetics expert, is a member of Research Society for the Study of Diabetes in India.

Image courtesy: Flickr/creativecommons aNantaB