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Most of us know someone who has diabetes, which is actually no surprise, given that India topped the world’s highest number of diabetics in 2014 (with 62 million people afflicted with the metabolic disorder). It doesn’t help that Indians have a genetic predisposition to this prevalent condition that’s now considered to be an epidemic.1,2

 

The Bigger Picture of Diabetes

We’ve previously given a detailed account of how one can develop insulin resistance, the underlying cause of type-II diabetes.

In short, (type II) diabetes develops when our cells become resistant to the glucose-lowering effects of a hormone called ‘insulin’, which also results in an imbalance of our insulin levels, giving rise to dangerously high levels of blood glucose.

Today, the definition of diabetes goes far beyond just a glucose-processing disorder. By affecting every aspect of our metabolism, it significantly alters the breakdown and requirements of other nutrients, too.

While we do know that diabetes is connected to obesity, the finer details of the how and why are yet to be uncovered.3 That’s why we don’t have a cure for the metabolic mayhem that ensues, which ultimately creates problems related to our blood vessels, kidneys, eyes, nerves and skin.4

Amid the vast amount of information and approaches to managing diabetes, one thing remains certain: the right nutrition and a healthy lifestyle are powerful tools in managing this disease.

 

Nutrition for Diabetics

Understanding basic nutritional guidelines can go a long way in helping diabetics manage the disease and their long-term health.

Here’s how we need to consume specific nutrients, and why.

1] Carbohydrates

Carbohydrates break down into sugars, which is why they should ideally be restricted to about 20% (up to 40%) of our total calorie intake, but the optimal quantity could vary depending on each individual. It’s best to measure your blood glucose with a metre before a meal and then 1-2 hours after eating (where it should remain below 140mg/dL or 8mmol/L).

Of the various carbohydrate sources, whole grains are great for diabetics because they have a low GI (glycemic index), which means that, once digested, they release energy slowly, keeping blood sugar levels more stable – a crucial part of diabetes management.

Whole grains are also rich in dietary fibre, a very important addition to a diabetic’s diet as it helps manage blood sugar levels, increases satiety and helps reduce triglycerides and LDL cholesterol. Non-starchy vegetables (e.g. spinach, bottle gourd, zucchini, cauliflower, cabbage) and low GI fruits (like apples, cherries, grapefruit, pears, oranges, and plums) are great sources of soluble and insoluble fibre, both of which have tremendous health benefits for diabetics.6 Fibre also promotes the growth of our gut’s good bacteria, which not only help with digestion but also mediate many functions of metabolism.

Other nutrient-dense, high-fibre carbohydrate sources include vegetables, berries, nuts and seeds.

When it comes to rice, there are some varieties that have a low GI (around 50, on the scale of 1 to 100) as well, which can be identified at your local store.5

 

2] Protein

Adding protein to every meal helps manage blood sugar levels, as it slows down the absorption of glucose.

There’s more – with type 2 diabetes, moderately high blood sugar can make the body use up more protein than usual. That makes it even more important for diabetics to get the standard recommended amount of protein (0.8 to 1.2 g/kg bodyweight), which isn’t always consumed.

An amino acid called taurine (found in fish, meat, and sea plants) could be particularly helpful, since it improves the absorption of water and nutrients by the cells – something that can otherwise be adversely affected by the metabolic mayhem that accompanies diabetes.7, 8 Fish is also healthy for diabetics because, in addition to taurine, it contains a protein called collagen, the supplementation of which has been shown to reduce insulin resistance.9

 

3] Fats

As counterintuitive as it may seem, fats are a very important part of our diet, especially when a whole food group (carbs) is restricted.

That’s because carbs are the body’s biggest source of fuel. When they’re restricted and there aren’t enough fats either, the body turns to protein for energy, using up the amino acids (smaller blocks of protein) from our diet that are needed for other critical functions.

Consuming a sufficient amount of fats would leave more protein available for the rest of the body by providing an additional source of energy.

This is particularly true for the brain, which predominantly uses carbs for energy, but can switch to using fats for the same when carbs are limited (as in the case of the currently popular ketogenic diet).

Healthy fats from sources like flaxseed, avocados, coconut, ghee, olive oil etc. should be included in the diet, while avoiding trans-fats (the bad fats) found in baked goods, refined vegetable oils (when cooked), and many food products (with “hydrogenated oil” and “shortening” in the ingredients list).

Omega-3 fatty acids from sources like fatty fish, flaxseeds and avocadoes are expressly advised for diabetics, since they can lower their increased risk of heart disease.

 

4] Micronutrients

Vitamin D:

Studies have suggested that having low levels of vitamin D is associated with a larger fat mass, a greater risk of weight gain and (over time) diabetes. Whether this is a cause or effect of diabetes is not known, but keeping up your vitamin D levels to the mark will do you good either way.10

Minerals

Diabetics are more prone to developing deficiencies in some minerals, notably potassium, magnesium, and zinc.10 Seafood, meat, green leafy vegetables, seeds and nuts can give you a good mix of these.

Antioxidants

Diabetes, especially when controlled less than thoroughly, is associated with an increased accumulation of free radicals in the body or impaired antioxidant defences (due to the high blood sugar and other metabolic struggles).4

Free radicals can wreak havoc when in excess – but their damage can be neutralised by antioxidants

Many compounds from plant sources (called phytonutrients) are good antioxidants, the following being notably good for diabetics:

Turmeric – Its active component, curcumin, is a powerful antioxidant that can lower blood sugar and LDL, and help manage other complications of diabetes.11

Cinnamon – It has compounds that decrease insulin resistance, lower blood sugar, and reduce LDL.12-14

Grape seed extract – It has phytonutrients called proanthrocyanidins that have an exceptionally high antioxidant capacity– insomuch that they are being compared to the effects of an anti-diabetic drug called metformin.15

While keeping these general guidelines in mind, we should ideally get the guidance of a healthcare professional to plan our diet periodically, to account for individual complications and monitor them over time. In addition to these dietary considerations, the importance of physical exercise cannot be overstated for diabetics. Increased physical activity (through exercise and general movement) can lead to improved blood sugar levels, decreased insulin resistance, and a reduced risk of heart disease. Reduced stress levels and better sleep quality also help control the condition.

Considering that diabetes affects almost every aspect of our metabolism, and seemingly vice versa, a complete lifestyle change, even in baby steps, can go a long way.

 

 

References:

 

1. Kaveeshwar SA, Cornwall J. The Australasian Medical Journal 2014, 7(1): 45-48.

2. Radha V, Mohan V. Indian J Med Res 2007, 125(3): 259-274.

3. Muoio DM. Diabetologia 2012, 55(10): 2551-2554.

4. Maritim A, et al. Journal of biochemical and molecular toxicology 2003, 17(1): 24-38.

5. Boers HM, et al. The British Journal of Nutrition 2015, 114(7): 1035-1045.

6. Venn BJ, Mann JI. Eur J Clin Nutr 2004, 58(11): 1443-1461.

7. Sirdah MM. Diabetes Metab Syndr 2015, 9(1): 55-64.

8. Chen W, et al. Food & Function 2016.

9. Zhu CF, et al. Appl Physiol Nutr Metab 2010, 35(6): 797-804.

10. Chehade JM, et al. Diabetes Spectrum 2009, 22(4): 214-218.

11. Zhang D-w, et al. Curcumin and Diabetes: A Systematic Review, vol. 2013, 2013.

12. Kawatra P, Rajagopalan R. Pharmacognosy Research 2015, 7(Suppl 1): S1-S6.

13. Rao PV, Gan SH. Evidence-based Complementary and Alternative Medicine : eCAM 2014, 2014: 642942.

14. Howard ME, White ND. ?American Journal of Lifestyle Medicine 2013, 7(1): 23-26.

15. Shi J, et al. J Med Food 2003, 6(4): 291-299.

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