The Diabetic Diet

By- Meena Ganagani,Practicing Clinical Nutritionist,Mumbai.

Diabetes is a major public health problem that is approaching epidemic proportions globally. Worldwide, the prevalence of chronic, non-communicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major predisposing factors. Diabetes is certain to be one of the most challenging health problems in the 21st century. (1)

Healthy eating can help you prevent, control, and even reverse diabetes. People with diabetes have nearly double the risk of heart disease and are at a greater risk of developing mental health disorders such as depression. But most cases of type 2 diabetes are preventable and some can even be reversed. Taking steps to prevent or control diabetes doesn’t mean living in deprivation; it means eating a tasty, balanced diet that will also boost your energy and improve your mood. (2)

What is a diabetic Diet?

A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes.

A diabetes diet is a healthy-eating plan that’s naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. (3)

Nutrition and physical activity are important parts of a healthy lifestyle when you have diabetes. Along with other benefits, following a healthy meal plan and being active can help you keep your blood glucose level, also called blood sugar, in your target range. To manage your blood glucose, you need to balance what you eat and drink with physical activity and diabetes medicine, if you take any. What you choose to eat, how much you eat, and when you eat are all important in keeping your blood glucose level in the range that your health care team recommends.(4)

Healthy eating and Diabetes

If you have diabetes, healthy eating can help you to:

  • Maintain general good health
  • Better manage your blood glucose levels
  • Achieve target blood lipid (fat) levels
  • Maintain a healthy blood pressure
  • Maintain a healthy body weight
  • Prevent or slow the development of diabetes complications.

Diabetes and Carbs

Planning what to eat and when to eat is very important—especially if you have diabetes. Counting carbohydrates or carbs—adding up all the carbs in everything you eat and drink—can help people with diabetes manage their blood sugar levels.(5)

Carbohydrate counting, or “carb counting,” helps many people with diabetes manage their food intake and blood sugar, and it’s most often used by people who take insulin twice or more times a day.
Carb counting may give you more choices and flexibility when planning meals. It involves counting the number of carb grams in a meal and matching that to your dose of insulin. With the right balance of physical activity and insulin, carb counting can help you manage your blood sugar.

Protein and Fat

Along with carb counting, protein and fat in meals are also a factor but have less impact on your blood sugar than carbohydrates. Foods high in protein often contain fat, and both protein and fat can affect your blood sugar. While there is currently no clear method of counting grams with protein and fat to predict impact on your blood sugar, if you notice unexpected outcomes in your blood sugar when you eat foods high in protein and/or fat.(6)

Fibre and Diabetes

Increasing the amount of fibre in your diet can help you manage your diabetes. It also helps keep your gut healthy and can reduce your blood cholesterol, which lowers your risk of cardiovascular disease. If you are trying to maintain a healthy weight, it can also be beneficial.(7)

Micro-nutrients and Diabetes

A deficient supply of nutrients can exacerbate the condition. Targeted consumption of micro-nutrients can help improve metabolic control, optimize treatment and reduce the risk of developing diabetic complications. Key to this is an adequate intake of B vitamins, which protect the nerve cells, vitamins C and E, which can help prevent vascular damage, and magnesium, which promotes normal glucose metabolism. Further, the lipid -lowering and antithrombotic properties of omega-3 fatty acids and trace elements that improve insulin sensitivity can all be beneficial in primary and secondary prevention.(8)

Glycemic Index

The glycemic index (GI) ranks foods according to how quickly they raise blood sugar levels.

Foods with high GI scores increase blood sugar levels rapidly. These foods include sugars and other highly processed carbs.

Foods with low scores contain no or few carbs or they contain fiber, which the body does not absorb as quickly as processed carbs.

Here are some examples of carbohydrate-rich foods and their GI scores:

Low-GI foods (with scores of 55 or less): 100% stone-ground, whole-wheat bread, sweet potato with the skin, most fruits, whole oats

Medium-GI foods (56–69): Quick oats, brown rice, whole-wheat pita bread

High-GI foods (70 and above): white bread, russet potatoes, candies, white rice, melon

People with diabetes need to consider the type of carbs as well as how many they consume. A doctor can give advice about this. (9)

Fat and Diabetes

Fat is very high in calories with each gram of fat providing more than twice as many calories compared to protein and carbohydrate.

Eating too much fat can lead to you taking in more calories than your body needs which causes weight gain which can affect your diabetes control and overall health. The type of fat is important too. Having too much saturated fat in your diet can cause high levels of what’s known as ‘bad cholesterol’ (low-density lipoprotein or LDL), which increases the risk of cardiovascular disease (CVD). (10)

Sugar Intake

Diabetes makes it difficult for the body to use glucose effectively. Since the body converts both naturally occurring and added sugars into glucose, people with diabetes must monitor their overall sugar intake.

But some foods affect blood glucose levels more than others, depending on their glycemic index (GI). Foods with a higher GI raise blood glucose more than foods with a lower GI.

Avoiding added sugars and focusing on consuming the right amounts of fiber and nutrient-dense carbohydrates from whole foods can help stabilize blood sugar levels. (11)

Basic eating guidelines for diabetes

If you have diabetes, follow a simple healthy eating plan, which includes:

  • Eat regular meals throughout the day. 
  • Make vegetables the main part of your meal. Aim to fill at least half of your plate with non-starchy vegetables or salad at both lunch and dinner time. 
  • You may need to reduce the serving size of your meals and snacks, as eating too much can lead to weight gain and make diabetes harder to manage.
  • Include a small serving of high-fibre carbohydrate at each meal. Examples of high-fibre carbohydrate foods are wholegrain bread, cereals, wholemeal pasta, brown rice, quinoa, fruit and starchy vegetables (such as corn, sweet potato and potato). 
  • Choose reduced-fat or low-fat dairy products. Look for those with the least amount of added sugar. Greek yoghurt with fresh fruit is a good choice.
  • Choose lean meats and alternatives, such as skinless chicken and turkey, fish, eggs, legumes (beans, lentils), tofu and nuts.
  • Limit the unhealthy (saturated) fats that are found in foods such as full-fat dairy products, butter, cream, fatty and processed meats, fried foods, cakes, pastries, and foods containing palm oil and coconut oil. 
  • Include some of the healthy (unsaturated) fats like olive, canola or sunflower oil, monounsaturated or polyunsaturated margarines, oily fish, avocado, seeds and nuts.
  • Oily fish is great for heart health. Aim to include oily fish such as salmon (tinned or fresh), sardines, mackerel, herring or tuna at least two to three times per week. 
  • Save baked items like cakes and biscuits, slices and desserts for special occasions.
  • Avoid sweet drinks (soft drink, cordial, sports drinks, flavoured waters and energy drinks).
  • Don’t add salt when you cook or at the table and reduce the use of high-salt foods.
  • Use herbs and spices to add flavour to your food.
  • Limit alcohol to two standard drinks per day, with some alcohol-free days each week.(12)

Prevention of Hypo-glycemia

  • Hypoglycemia usually occurs more frequently in PWD taking insulin, but can occur in those taking oral antihyperglycemic agents, especially a sulfonylurea. To help prevent hypoglycemia, the following guidelines should be discussed:
  • Don’t skip or delay meals or snacks. If taking insulin or oral diabetes medication, be consistent about the amount eaten and the timing of meals and snacks.
  • Monitor blood sugar. Depending on treatment plan, check and record blood sugar level several times a week or several times a day. Careful monitoring is the only way to make sure that blood sugar level remains within the individual target range.
  • Measure medication carefully, and take it on time. Take medication as recommended by the physician coordinating diabetes care.
  • Adjust medication or eat additional snacks if physical activity increases. The adjustment depends on the blood sugar test results and on the type and length of the activity.
  • Eat a meal or snack if choosing a drink with alcohol. Drinking alcohol on an empty stomach can contribute to hypoglycemia.
  • Record low glucose reactions. This can help the health care team identify patterns contributing to hypoglycemia and find ways to prevent them. (13)

The ICMR recommends adoption of a diet containing carbohydrates (55–60%) including cereals, mixed coarse grains, whole pulses, salads and soybeans; proteins (10–15%) from vegetable sources, low fat milk and milk products, fish and lean meat; fats (20–25%) comprising < 7% of saturated fats and the major proportion from MUFA and polyunsaturated fatty acids (PUFA).

 

References:
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068646/
  2. https://www.helpguide.org/articles/diets/the-diabetes-diet.htm
  3. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
  4. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity
  5. https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html
  6. https://www.diabetes.org/nutrition/understanding-carbs/carb-counting
  7. https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/carbohydrates-and-diabetes/fibre-and-diabetes
  8. https://www.nutri-facts.org/en_US/news/micronutrients-and-diabetes.html
  9. https://www.medicalnewstoday.com/articles/318277#bringing-it-all-together
  10. https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/food-groups/fats-and-diabetes
  11. https://www.medicalnewstoday.com/articles/324673#added-sugar-vs-natural-sugar
  12. https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/diabetes-and-healthy-eating
  13. https://www.ncbi.nlm.nih.gov/books/NBK279012/
  14. https://link.springer.com/article/10.1007/s12325-019-0872-8

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