Dietary Issues

The connection between diet and metabolic diseases is now well established. Yet very few dietary surveys have been done in New Zealand or India with reference to chronic diseases such as diabetes. Dr. V. Mohan - who is spearheading a large ongoing study called the Chennai Urban Rural Epidemiological Study (CURES) has undertaken the first such survey in Chennai. Dietary intake of 2042 individuals was measured using an interviewer-administered questionnaire.

It was found that carbohydrates are the major source of energy (64 per cent) followed by fat (24 per cent) and protein (12 per cent). Refined cereals such as polished rice contribute to bulk of the energy (45.8 per cent) followed by visible fats and oils (12.4 per cent) and pulses and legumes (7.8 per cent).

Contrary to my New Zealand experience, he notes that energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient- rich foods, such as fruit and vegetable, fish and seafoods was far below recommended level.

A diet rich in refined cereals with low intake of fish, fruit and vegetables is increasing the risk of diabetes (Mohan 2010). The fact that Indian food has become less healthy has worried public health experts. India's rapid urbanization has resulted in dietary changes in recent years that are linked with increasing obesity and higher disease rates, especially diabetes. In rural India, diabetes prevalence is only two to six percent, while in urban areas it is 12 percent. Indians living in Western nations experience a four-time greater overall rate of diabetes compared with those living in India. (Mohan 2010).

Ideal Nutrition

There is scientific consensus that a disease-protective diet is high in fruits, vegetables, whole grains and other plant-based foods; and low in animal fats, salt, refined grains and sugars. A traditional Indian diet can be adapted to fit this description. In fact, the National Cancer Institute reports that cancer rates are lower in India than Western countries, and that diet characteristics such as high intake of fruits, vegetables, spices and tea might be responsible for protecting Indians against certain forms of cancer. (Gadia 2010)

An example of healthy components of the Indian diet:

Vegetables. Indian cuisine includes many vegetables combined flavourfully in dishes, such as beets, Brussels sprouts, cabbage, carrots, cauliflower, celery, cucumber, corn, eggplant, green beans, greens, okra, onions, peas, peppers, potatoes, radishes, spinach, squash and tomatoes.

Grains. Whole wheat flatbreads and basmati rice are popular in Indian home-cooked meals, but wholegrains such as buckwheat and amaranth should be encouraged as alternatives.

Legumes. These are a good source of protein and complex carbohydrates, such as: black-eyed peas, chickpeas, lentils and beans.

Fruits. Apples, apricots, bananas, figs, grapes, guava, lychee, loquat, mangoes, oranges, papayas, passion fruit, and sweet limes are common fruits in India.

Dairy. From milk and buttermilk to yogurt and paneer (fresh cheese), dairy products are regular features of the Indian diet. Encourage low fat options.

Herbs and Spices. At the heart of Indian food is a list of culinary herbs and spices that have been used for centuries, many of which are proven to have antioxidant, anti-inflammatory, antimicrobial, and anticancer qualities. Indian spices include amchur (made from mangoes), aniseed, asafetida (a pungent, onion-like flavour), bay leaf, black pepper, cardamom, chillies, cinnamon, clove, coconut, coriander, cumin, dill, fennel, fenugreek, garam masala (a spice blend), garlic, ginger, mango powder, mint, mustard, nutmeg, onion seeds, parsley, pomegranate seeds, poppy seeds, saffron, sesame seeds, tamarind and turmeric.

Small Amounts of Meat. Since vegetarianism is common in India, a delicious cuisine has developed to include many vegetarian dishes. Even non-vegetarians tend to eat smaller amounts of meat and frequent vegetarian meals.

The heavy side of Indian food. Traditional, homecooked Indian food is typically low in fat and rich in vegetables and whole grains. But the opposite is often true of food prepared in restaurants. Home cooked meals would hardly ever use cream in a curry or sauce, but at an Indian restaurant it often uses cream as a base (Gadia 2010).

Westernisation has influenced Indian cooking, especially those prepared with a sauce, tend to be high in vegetable oils and added salt. Popular items now include deep-fried appetizer like samosa, and plate-sized servings of naan (flatbread) made with white flour. It's easy to see how a healthful cuisine can turn into an indulgent food feast. Most Indian restaurants have fallen into the same restaurant food trap that other ethnic establishments have fallen into instead of following authentic cooking traditions, they often westernize recipes and add extra fat and salt. It is suggested Indian food lovers encourage restaurant owners to create a movement for healthier food.

Current Dietary Trend

Carbohydrates: Traditionally up to 65% of total calories have come from complex, high fibre carbohydrates. The traditional vegetarian Indian diet that includes coarse grains, whole wheat, kaffir corn, maize, amaranth and ragi that contain almost four times more fibre than refined cereals or processed foods. Eating high fibre foods helps control blood sugar, is filling and reduces the need to snack frequently.

It is the unbalanced diet that is worrisome. The lack of proteins, combined with low fruit and vegetable intake and rising consumption of sugared beverages and now, fat (including pizzas, burgers and other fast food) increase the population's risk for cardio vascular disease and diabetes (Mohan 2010).

Another important source of carbohydrates is legumes that are high in the kind of glutinous fibre known to give better glycemic control and also reduce cholesterol. Legumes also contain minerals such as magnesium and chromium that play a role in carbohydrate metabolism. The added benefit of legumes is that they are a major source of protein.
This is beneficial to diabetics in avoiding sudden rises and falls in blood glucose levels. Legumes are caloric dense, but they give carbohydrates and protein all at once, so include them in every meal and as a substitute for meats. (Anonymous. 2010)

Fat: Overall oil consumption should not exceed 20 per cent of the total calories or not more than 40gm per day as recommended by the Indian Council of Medical Research (ICMR). Surprisingly some of the healthiest oils are what Indians traditionally use mustard, sesame, groundnut and cottonseed. These are healthier than corn or safflower oils in the Indian context. Olive oil may be included in the daily diet. It is prudent to use a combination of oils as each has different proportion of saturated, monounsaturated and polyunsaturated fats, however, our diets tend to include a higher percentage of Omega 6 oils from grains, fruits and polyunsaturated oils, so it is advisable to encourage Omega 3 oils from fish, flax and hemp seeds. Olive oil is the choice for cooking.

Refined sugar should be avoided, as they contribute nothing but empty calories and has no nutritional benefit. Fresh and cooked vegetables should form a regular part of the main meals. These are beneficial in reducing cholesterol.

Cook vegetables in minimum oil, its better to steam, stew or stir fry. All fruits are good for the diabetic and should be an essential part of the meals or as in between snacks. Fruits contain fibre, vitamins and antioxidants that protect against cardiovascular diseases.

Protein: The healthiest non-vegetarian source of protein is fish, followed by lean meats such as chicken and turkey. Red meats, sausages, ham, organ meats, poultry with skin (as found in fast foods) contain saturated fats and therefore not recommended.

Low fat cow's milk, buttermilk, paneer, cottage cheeses are essential in moderate amounts. Milk is a wholesome food providing protein, vitamins and minerals and also is one of the foods with the least glycemic index. Low fat cow's milk products make excellent between-meal snacks. Eggs are also an excellent protein source. Vegetarian sources of protein include nuts, lentils, beans and pulses, grains, tofu and soy and nut milks and butters.

'The diabetic who knows most will live the longest' -- Dr. Elliot P Joslin

Dietary discipline can prevent the risk of developing diabetes and avoid risks of complications in known diabetics. There is no 'diabetic diet' per se. There is only a healthy eating plan within a caloric frame that means eating the right amounts of nutritious foods at specified times, according to one's age, weight, physical activity, medication, and special situations. All the different kind of foods must be included daily, because a diabetic needs good amounts of vitamins and minerals for optimal metabolism.

Diet Recommendations

To help Reverse Insulin Resistance and Diabetes:

1. Optimise Nutrition

2. Balance Hormones, including stress hormones

3. Reduce inflammation and its markers

4. Enhance digestion

5. Enhance detoxification

6. Energise metabolism

7. Calm the mind (Hyman, 2009)

Eating in a way that balances blood sugar, reduces inflammation and oxidative stress, and improves liver detoxification is the key to preventing and reversing insulin resistance and diabetes.

This is a way of eating based on a whole foods diet that's high in fiber, rich in colorful fruits and vegetables, and low in sugars and flours, with a low glycemic load. It is a way of eating that includes anti-inflammatory, antioxidant, and detoxifying foods. It includes plenty of omega-3 fats and olive oil, beans, nuts, and seeds. This is very different to placing bread and starch at the base of the 'traditional' food pyramid.

All these foods help prevent and reverse diabetes and insulin resistance. This way of eating turns on all the right gene messages, promotes a healthy metabolism, and prevents aging and age-related diseases like diabetes and heart disease (Hyman, 2009.

Specifically Meal Timing:

1. Eat protein for breakfast every day, such as whole omega-3 eggs, protein shake, or nut butters

2. Eat something every 4 hours to keep your insulin and glucose levels normal

3. Eat small protein snacks in the morning and afternoon, such as a handful of raw mixed nuts

4. Finish eating at least 2 to 3 hours before bed

Meal Composition:

1. Controlling the glycemic load of meals is very important

2. You can do this by combining adequate protein, fats, and whole-food carbohydrates from vegetables, legumes, dal, nuts, seeds, and fruit at every meal or snack

3. It is most important to avoid eating quickly absorbed carbohydrates alone, as they raise your sugar and insulin levels (eg avoid flour products like roti, naan, chipatti, cake, bread and pasta, eat the whole fruit rather than fruit juice.)

Travel Suggestions:

Two handfuls of mixed nuts in a zip-lock bag make a useful emergency snack. You can eat them with a piece of fruit. Remember, real food is the best. (Hyman 2009)

AVOID these foods and drinks:

Indian Sweets including Barfi, Ladu, Gulabjamun, Mohanthar, Khuja, Lakri Methai, Halwa, Gojiya, and other sweet treats.

Fried foods add a lot of unnecessary calories, plus the act of heating the oil or fat damages its composition, turning them into trans fats. Trans fats are known to raise your bad LDL cholesterol and lower your good HDL cholesterol, thereby increasing the risk of cardio vascular disease (CVD). Trans fats also have an inflammatory effect on the whole body. Inflammation is at the route of diseases including obesity, diabetes, heart disease, immune disorders and cancer.

Alcohol, many Indian men indulge in a high volume of alcohol, often in the form of spirits such as whisky. This contributes to the high carbohydrate intake, plus detrimental effects on blood sugar, the liver, the body in general and family life.

Fizzy drinks contain around 10% sugar which equates to a 300ml can containing approximately 6 teaspoons of sugar. This has the effect of quickly raising blood sugar, which goes against the principle of the desirable low GI diet which is designed to provide sustenance/sugar release at a slow and steady rate. These sweet products also contain High Fructose Corn Syrup (HFCS) a man-made sweetener shown to be adipogenic, this means it causes weight gain at a higher rate than ordinary sugar.

Fruit Juice often contains even more sugar than fizzy drinks with up to 14%. Don't be fooled by the advertising highlighting added Vitamin C. Eat real whole fruit instead, that way you get the fibre as well which lowers the GI factor.


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