After the food habits of incarcerated Delhi Chief Minister Arvind Kejriwal stirred up a debate as the Enforcement Directorate (ED) revealed the details of his high glycaemic index diet this week, the lifestyle disease, which results from a combination of genetic and lifestyle factors, is a complex one and diet -- along with daily exercise -- plays a key role in its management.
A proper healthy and nutritional diet can help aptly manage the incurable condition, which if ignored, can affect nearly all organs.
Uncontrolled diabetes can lead to multiple complications ranging from kidney problems -- failure, dialysis, and transplantation, to blindness, amputation, heart attacks, strokes, dementia, nerve problems, and gangrene.
The condition can also affect sexual health and cause infertility, among others.
What is diabetes?
The World Health Organisation (WHO) defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin (blood glucose regulating hormone), or when the body cannot effectively use the insulin it produces.
Both raised glucose levels, called hyperglycaemia, and low glucose levels, called hypoglycemia, can lead to serious damage to many of the body's systems, especially the nerves and blood vessels.
Globally, diabetes affects more than 50 crore people, according to a study published in the journal The Lancet. It projects the number to more than double to 130 crore people in the next three decades.
In India, a whopping 10.1 crore people suffer from diabetes, while 13.6 crore are pre-diabetic, reveals data from the Indian Council of Medical Research (ICMR).
According to top diabetologist Dr V. Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre, "diet, high calories, weight, increase in obesity are the major drivers, and there is a small genetic factor, which makes Indians a little bit more prone".
He also blames rising consumption of junk food -- known to be rich in salt and sugar --, no exercise, disturbed sleep patterns, rising pollution levels, adulteration of food, and their contamination with pesticides behind the diabetes epidemic in the country.
Diet management in diabetics
While it is important to eat a healthy diet rich in fruits and vegetables, controlling portion size and carbohydrate levels is key for diabetic patients. Food items can also be classified based on their glycaemic index (GI) levels. GI is a value assigned to foods, especially those rich in carbohydrates, and determines how quickly the foods can spike blood glucose levels in the
body. High-GI food can cause a rapid spike in blood glucose levels, followed by a swift decline. These high-GI foods raise the demand for insulin, leading to the risk of developing Type-2 diabetes and worsening in diabetes patients.
On the other hand, low-GI food helps prevent diabetes, as well as its complications like heart disease, obesity, and cancer.
Researchers at Harvard T.H. Chan School of Public Health, in a recent study, revealed that consuming a low-carbohydrate diet which primarily includes plant-based foods can significantly lower the risk of premature death among people with diabetes.
Dr Sudhir Kumar, a neurologist at Indraprastha Apollo Hospitals, says "carbohydrate restriction" is key.
"This can be achieved by avoiding or restricting sugar, jaggery, honey, etc. Sugar-sweetened beverages (soft drinks, packed fruit juices) and sweets should be avoided, " he said while stressing the need to minimise "intake of rice, roti, idli, dosa, potatoes, and fruits".
Can diabetic patients eat fruits, and drink tea, and coffee?
The concern has been that fruits contain sugar. However, most fruits have low to medium GI, compared to other carbohydrate-containing foods like white or wholemeal bread.
Acclaimed celebrity nutritionist Rujuta Diwekar says that "when it comes to local, seasonal fruits, the truth invariably lies beyond the fear of calories, sugar, and weight gain".
She also vouches for mangoes, known to be rich in antioxidants, fibre as well as Vitamin C, over "green tea, oats, pills" for better nutrients.
But can the same be applied to a person with diabetes? Contrary to popular myth, mangoes do not have a high glycemic index.
According to Rujuta, "mangoes are not only safe for diabetics, but they are also, in fact, recommended for people with diabetes because of their rich profile of nutrients. They are rich in phytonutrients, antioxidants, and fibre".
Portion size may be key here.
Mayo Clinic’s M. Regina Castro, MD, in a recent paper, revealed that the quantity of carbohydrates in a determines blood sugar levels more than "the source of the carbohydrates or whether that carbohydrate source is a starch or sugar".
"As you decide what fruit to eat, keep in mind that one serving of fruit should contain no more than 15 grams of carbohydrates. So, the size of the serving depends on how much carbohydrates are in the fruit."
Diabetes UK explains that a portion of fruit, similar to a slice of bread, contains about 15-20g of carbohydrates on average. On the other hand, a can of cola contains 35g of carbs and a medium slice of chocolate cake contains 35g of carbs.
Further, while sugar-sweetened beverages like colas and fruit juices can spike blood sugar levels, drinking more coffee, or tea may not be harmful.
A recent study by Harvard T.H. Chan School of Public Health showed that drinking more coffee, tea or plain water may lower Type 2 diabetes patient’s risk of dying prematurely from any cause by about 25 per cent.
But the study, published in the BMJ, calls for diabetics to cut down the intake of fizzy drinks, cakes, biscuits, chocolate, and other snacks; and also to limit the intake of starchy foods, particularly those that are highly processed and contain added fats, sugars and salt.
At the same time, consuming healthy carbohydrates, such as fruits, vegetables, whole grains, legumes, such as beans and peas, and low-fat dairy products, such as milk and cheese, while being mindful of portion size, can help manage diabetes effectively.
Role of exercise
In addition to diet, studies also reveal aerobic exercises and strength training along with abstinence from tobacco and alcohol and medications to fight diabetes.
A recent study published in the American Journal of Medicine Open, reveals that aerobic exercise which includes cycling, swimming, and walking, and resistance exercise such as using dumbbells, resistance bands, or bodyweight exercises, enhances insulin sensitivity, a vital factor in controlling Type 2 diabetes.
Another research from the University of Alberta in Canada shows that a combination of diet and exercise may not stop the progression of diabetes but can also put the disease into remission.