This is the age when most of us would love to have our cake and eat it too. Unfortunately, this is also the age when most of us literally cannot do it—thanks to the host of lifestyle diseases on the prowl and the dozens of dietary restrictions to prevent these diseases from striking.
Imagine being told that you cannot have the king of fruits any more. If there is one regret that most diabetic patients have, it is that fruits such as mango, chikoo, custard apple and banana are among the first things to be removed from their diet—apart from sugar, honey and a host of other sweet products.
Rice eaters feel discouraged when they hear that it is easier to manage their condition with wheat-based diets.
But, with advances in nutritional science, doctors and nutritionists are working in tandem to come up with diets that actually allow diabetics to have these products. “It is difficult for those who are rice eaters to switch over to wheat overnight,” says Kajal Pandya, chief nutritionist, Sitaram Bhartia Institute of Science & Research in New Delhi.
So, instead, nutritionists like her tend to make small changes such as making sure the kind of rice consumed is not polished rice or they reduce the Glycemic Index (GI) of the rice dish by adding a lot of vegetables to it. “If you ask me, there is no such thing as a diabetic diet—it is a normal diet,” says New Delhi-based nutritionist Ishi Khosla, stressing that sugar needs to go out of the normal diet as well.
Endorses Sujeet Jha, consultant endocrinologist, Max Healthcare, New Delhi: “There is a myth in our society that people with diabetes should not eat any sweet fruits such as mangoes, grapes and cherries but they can eat digestive biscuits. The standard rule of five fruits a day is true for patients with diabetes as well. The GI of mango (58) is similar to that of biscuits while cornflakes have a high Glycemic Index of 82.”
So, what is GI, that along with terms such as Glycemic Load (GL) and food exchange theory is a buzzword today? Well, these are terms that are increasingly gaining relevance because medical science has accepted the fact that nutrition has a big role to play in the prevention, management and cure of diseases. Chances are that if you are a diabetic, the next stop after a visit to your doctor will be to a nutritionist, which would not have happened till a few years ago, when your general practitioner would simply have told you to eliminate several foods from your diet, exercise and maintain an optimum weight.
Today, research has revealed that in lifestyle diseases and conditions such as cancer, heart ailments and diabetes, nutrition has a vital role to play—both in aiding recovery and in actually managing the condition. And, for this, nutritionists use measurement tools such as GI.
Basically, GI refers to the extent of rise in blood sugar in response to a food in comparison with the response to an equivalent amount of glucose.
To explain it in simple terms—carbohydrates are the major sources of the fuel for the body and are mainly found in “starchy” foods such as bread, cereals, grains, pasta, fruits and vegetables. The difference in the body’s response to carbohydrate ingestion gave rise to the concept of GI. The lower the GI of carbohydrates, the less will be the rise in sugar levels after meals in diabetics
As Dr Jha explains: “One of the problems faced by diabetics is post-prandial (after meal) rise in sugar. Foods with a lower GI rating should cause a slower rise in blood sugar levels after a meal. Mixing foods that are low on the GI scale with foods that are high on the GI scale produce a medium GI—for instance, adding more green vegetables with your potatoes, or potatoes or white rice with rajma (kidney beans), chana chhole (grams).”
But relying solely on the GI is dangerous. Nutritionists are increasingly discovering the limitations of using this approach. Says Khosla: “Ice cream has a low GI (30). But that does not mean it is the food of choice for diabetics. In contrast, carrot has high GI, but we don’t discourage carrots.” This is where, says Khosla, concepts such as the GL and the food exchange theory have come in and are more commonly used by nutritionists. Basically, a GI value only tells you how rapidly a carbohydrate turns into sugar. It doesn’t tell you how much of that carbohydrate is in a serving of a particular food.
The carbohydrate in a carrot, for instance, has a high GI. But there isn’t a lot of it, so a carrot’s GL is relatively low. This is why calculating GL is the preferred approach of nutritionists when they make up diets—and this works not just for diabetics but also for those who want to lose weight.
The GL for a single serving of a food can be calculated as the quantity (in gram) of its carbohydrate content, multiplied by its GI, and divided by 100. A 100g slice serving of watermelon with a GI of 72 and a carbohydrate content of 5g (it contains a lot of water) makes the calculation 5x0.72=3.6, so the GL is 3.6.
Apart from the serving size, there are other factors that have to be taken into consideration. The speed at which the food is able to increase your blood glucose level is called the “Glycemic Response”. This Glycemic Response is influenced by many factors, including how much food you eat, how much the food is processed or even how the food is prepared (white potato eaten cold or baked has a lower Glycemic response than fried or mashed potatoes).
Of late, the GL theory is gaining so much currency abroad that an article in Harvard Health even joked that marketers might next start labelling a product “With Low Glycemic Load” just as they advertise a product as “Low Cholesterol”.
Meanwhile, even as they keep factors such as the GL in mind, nutritionists also like to offer variety and versatility to their diabetic patients. As Khosla says: “The chart system— two chapattis, one bowl dal and so on can get very tiresome for a patient. This is where they take recourse to the food exchange system, where foods are divided into six exchange lists. The lists are very much like the groups used in the food pyramid: starch/bread, meat and meat substitutes, vegetables, fruits, milk, and fat. You can “exchange” any food on the list for any other food on the same list—provided you know the measures.
So, if you would rather have a dosa in the morning than a multigrain porridge, you have to figure out how much of the dosa is equal to the bowl of porridge you are allowed to consume and eat accordingly.
Since all this could get too scientific at times, the role of a qualified dietician is really important to understand the concepts. And, now we finally come back to the mango on which, despite the relatively low GI index, the jury is still out. Even as Dr Jha endorses eating a mango, there are those like Dr Pandya who ruefully rule it out.
“It’s true that mango has a Glycemic Index of 58 but this is with the skin and we rarely consume mango with the skin,” points out Pandya. So, as she says, if you are willing to have your mango with the skin, then you can eat it, too.
ON A PLATTER
According to nutritionist Ishi Khosla, there is nothing like a diabetic diet—it is very much a normal diet, if you follow some basic rules.
1) Your weight should not exceed your expected ideal weight. You must stay within your recommended calorie intake.
2) Learn to use the exchange system to add variety to your diet. Rice eaters need not stop eating the grain.
3) Eat small, frequent meals to maintain an even Glycemic status. Divide your whole day’s ration into five to six small meals, rather than having two to three major meals. Don’t skip meals. A bedtime snack is very important to avoid hypoglycemia while you are sleeping.
4) Exercise is good for diabetics and should be a part of your daily routine but any additional physical activity on a particular day should be adjusted through your diet. In case, you have over-exercised, increase your food intake to prevent a low blood sugar.
5) Feasts and fasts should be strictly avoided.
6) Eat whole grain cereals such as wheat, jowar, bajra, ‘ragi’. Avoid simple sugars such as sucrose, glucose and fructose present in table sugar, honey, fruit candy, sweets, fruit juices, etc.
7) Use a variety of pulses such as chana, ‘rajma’, soya bean, ‘lobia’, ‘urad’, split pulses, etc.
8) Flours of soya bean, gram, barley and bajra can be incorporated into the wheat flour and chapattis made out of it, thus increasing the protein and fibre content of the chapatti. This improves the Glycemic response of the meal.
9) Green leafy vegetables and all types of raw vegetables such as cucumber, carrot, cauliflower, cabbage, lettuce, onion and tomato can be eaten in plenty to make you feel full and satisfied.
10) Use blended oils.
11) Choose cooking methods which require minimum amounts of fat. Eat stir-fried, boiled, steamed and grilled food instead of fried food. You can also use non-stick pans and oil sprays to reduce your consumption of fat.
12) Fibre-rich foods such as whole grains, pulses and vegetables and fresh and dry fruits should always be preferred to refined ones such as ‘maida’, polished rice and fruit juices.
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