Sudha Vasudevan, Sr Scientist & Head, Department of Foods, Nutrition & Dietetics Research (FNDR), Madras Diabetes Research Foundation & Dr Mohan’s Group of Institutions, explains the importance of maintaining a nutritional diet in diabetes management in an interview with Raelene Kambli
How can nutrition aid diabetes management? What nutritional principles would you suggest to your patients?
Diabetes is a chronic progressive metabolic disorder. Hence, to manage diabetes it is important to remove those dietary factors that aggravate the risk of diabetes and poor glycemic control (Example: Total calories, quantity and quality of carbohydrates and fats) while enhancing the diet with healthier foods that will mitigate this burden. Thus, the primary goal of diabetes management is to achieve normal blood glucose levels to retard or prevent diabetes complications and improve overall quality of life. The quality and quantity of carbohydrates consumed has the strongest influence on glycemic response especially the postprandial blood glucose. The protein requirement is similar to a person without diabetes (10-15 per cent of total calories) and diabetic kidney disease. Total fat and the type of fat can also influence the risk of diabetes as well as the cardiovascular complications of diabetes. Thus, balancing the quantity and quality (lower dietary glycemic load, higher MUFA fatty acids in the diet) and of these macronutrients (carbohydrates 55-60 per cent energy; Fat <30 per cent energy and protein 10-15 per cent energy and total calorie restriction); increasing the nutrient dense (vitamins and minerals) and intact dietary fibre rice sources would help achieve optimal nutrition.
In terms of key nutrients, besides carbohydrates and fats, does adequate intake of protein matter?
Protein from foods has shown to improve insulin secretion. However, the quality of protein is very important as many protein rich foods are also high in fats like meat, chicken etc. Vegetable protein foods like pulses and legumes are also rich sources of fibre that could also aid in blood glucose control. Similarly, dairy foods rich in protein has also been shown to have inverse association with the risk of diabetes (CURES study) from both national and international studies. In one of our five day continuous glucose monitoring clinical study carried out in overweight Indians have shown significant 24-hour reduction in glycemic response in the diet containing brown rice and legumes compared to white rice diet.
However, the protein intake goals should be individualised. For those with diabetic kidney disease (with albuminuria, reduced estimated glomerular filtration rate), dietary protein should be maintained at the 0.8 g/kg body weight per day while for others 1g/kg body weight is allowed.
What is the role of Low GI foods in managing diabetes?
Low GI foods elicit lower peaks of blood glucose and hence less insulin demand and easier way to control blood glucose. However, authentic low GI foods are very few in the global food market suggesting the challenges in developing healthy low GI choices. A review of many clinical trial studies on type II diabetes participants have shown that low GI diet helps in 0.5 per cent reduction in HbA1c ( ˜ 10.5 per cent reduction in the risk for deaths related to diabetes and its complications).
Can you provide some scientific evidence on the role of nutrition in managing Diabetes?
Dietary fibre shows strong inverse relation with the risk of type II diabetes. In a study carried out by Chennai Urban Rural Epidemiological study (CURES). The high GI and GL diet along with low fibre content increases insulin demand and further leads to reduced blood lipids and waist circumference and cardiovascular diseases. Both national and international studies have shown that substituting brown rice over white rice markedly lowers blood glucose and insulin levels (Sun et al., 2010 – a tudy by Harvard group, US; Mohan et al., 2014 – study by Madras Diabetes Research Centre, Chennai, India). Whereas data on the ideal total dietary fat content for people with diabetes are inconclusive. Diet emphasising elements of a Mediterranean-style diet rich in MUFA and omega 3 fatty acids by increased consumption of nuts, traditional oils like groundnut oil, mustard oil and canola oil have also shown beneficial effects on glucose and lipid levels in type II diabetes.
What are the nutritional factors that influence the development of type II diabetes?
Urban population-based, epidemiological cross-sectional study by CURES, showed that our diets continue to be high in simple carbohydrates, the major source of energy (64 per cent E), followed by fat (24 per cent E) and protein (12 per cent E). The commonly consumed highly polished white rice in India has a high GI value, and the refining process leads to a loss of bran and germ rich in micronutrients and phytonutrients. Higher intake of refined cereals, and a high glycemic-load diet was associated with metabolic syndrome and risk of type II diabetes in Asian Indians. The study also showed use of omega-6 poly unsaturated fatty acids (PUFA) rich vegetable oils like sunflower/ safflower oil can aggravate the risk of insulin resistance and metabolic syndrome in Asian Indians.
What role does food processing have on nutritional value of food?
With rapid urbanisation, there is a large shift from traditional foods to processed foods, canned foods and ready-to-eat snacks in both the developed and developing world. The advanced processing methods like milling of grains to yield refined grain or flour, canning of fruits and vegetables with added sugars or salt diminish essential food components like fibre, micronutrients and phytonutrients in the diet. Almost 80 per cent of the foods available in the market today are refined foods and are rich in hidden fat, sugar and extra added salt. It is advisable to avoid or minimise these foods in the diet of population with diabetes.
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