During my practice of last 35 years we
observed following things in patients
- Patients (Diabetics) eating 3,4 pkts of Marie Biscuits daily because his doctor advised that Marie Biscuits are good in diabetes.
- Patients eating plenty of thin “Khakaras” made from maida like flour as Doctor told that they are good for diabetics.
- Family members totally restricting fruits to the Diabetic patients as their Doctor told that Fruits will increase the Diabetes.
These observations prompted us to study and do some fact findings. To our utter surprise few unexpected findings came out. Most important is choice of food according to Glycaemic Index and its application in diabetes mellitus.
Glycaemic Index of a particular food is a relative measure of rise in blood sugar level campared to white bread. It is different from caloric value of same food.
High Glycaemic Indexed food will raise blood sugar quickly causing Hyperglycaemia, warranting more Insulin-loading to already weaker pancreas. It will also load more free fatty acids, more insulin resistance and unpredictable Hypoglycaemia afterwards. These foods are mainly foods of civilized society and machine mode food processing. Low Glycaemic Indexed food will make G.T.T. more flat, increase Insulin sensitivity and lower lipids and will decrease incidences of Hypoglycaemia.
List of few foods given bellow. Please note that there are some variations of Glycaemic Indices in different articles but message is same - Refined machine processed food is bad.
- Highest G.I. - Glycaemic Indices (> 100) Glucose, Maltose, Honey
- Very High G.I. (90-100)
Food from “Maida” and other highly refined and highly milled flours where bran is removed; e.g. White Bread, all biscuits and Bakery Products, Chapatties, Khakaras made of Maida and the refined flours, double polished white “rice”, sago, Mashed Potato, Potato Chips, Corn flakes, Jalebees, Samosas, Potato Vada, Fafda.
- Medium Glycaemic Index (50-90) daily cane-sugar (sucrose), fructose, lactose, coarse flours with bran retained, rice with minimum polish, parboiled rice, whole grains or Broken gains (Thuli, Daliya, Bharada, Lapsi-Ghugari) sprouted Beans. Fruits, fruit, juices, milk and milk products, Beat, Banana.
- Least Glycaemic Indexed food - Barley, All vegetables, and less sweet fruits, soups and vegetable juice, salads, Bengal gram, Tender Maize, Tender beans.
Most important message - comes that No. 1 culprit to Diabetes and related diseases like obesity, atherosis, metabolic syndrome is not daily table sugar but highly refined, highly polished, highly milled and highly cooked foods i.e. presently food eaten especially in fast life.
So, Sugar is safer than Bread and Potato in Diabetes Mellitus
Glycaemic Index depends upon following
- Size and composition of food particle, smaller the size. More will be G.I.
- Digestibility - Raw and natural foods have less Glycaemic Index.
- Cooking Methods - longer the cooking and more the pressure, higher will be G.I., Shorter cooking like Roasting will have lesser G.I. Hence Roasted Channa and other grams are much better and ‘Bhel’ will be very good.
- Gastric Emptying time : addition of fat will increase gastric emptying time and slow down absorption and decrease glycaemic index.
- Amount of Amylase and Amylopectin in food.
- Intestinal transient time.
- G.I. increases with refinement of food.
- It also depends upon phytates, lactins, tannins, saponins, enzyme Inhibition and most importantly upon fibres - soluble and insoluble.
It is easier to make selection of food items according to Glycemic Index in Diabetes and other related diseases in a given caloric value. Selection of lower. G.I. food will decrease hyperglycemic pecks, lower Hypoglycemic Indices and should be considered a therapy especially type II diabetics. It is also very useful in type I diabetics as it greatly helps insulin action and make easy to manage a difficult insulin dependant patients and avoid future complications.
- Highest G.I. like glucose should be used in hypoglycaemic incidences and not cane-sugar. (Grape Juice contains glucose).
- Very high G.I. foods should be restricted as far as possible. Those should be termed “sweet poisons”. Govt. should ban white bread and only brown whole grain bread should be allowed to sell. Marie Biscuits and Khakras (made of maida and Dalda) should not be allowed freely. They also increase craving.
- If it is not possible, one should add plenty of lower glycaemic indiced foods like salads, vegetables and mild products like Butter milk.
- Refinement of grain also removes bran which is highly nutrient. Bran also contains fibres, anti cancer and anti oxidant substances.
- Indigestible fibres also act as “Prebiotics”, decrease colonic bacteria load and hence decrease fermentations and toxins. It soften stool gives relief from constipation and constipation related diseases e.g. Piles, fistula, fissure, prolapse, etc.
- Cane sugar, Jaggery (Gud) should be allowed in restricted amount as it will increase palatability, satiety value especially that of salad.
- Rice - Minimally polished rice (which is not white) should only be used. Barley and Oat meal are supposed to be very good for diabetics.
- Fruits and Vegetables - should be eaten with skin (many people like it) as far as possible.
Fruits with high G.I. like Banana, Pineapple, grapes may be eaten in moderations. They are safer than Bread. Less sweet fruits should not be restricted at all - according to Glycaemic Indices.
Fruits juices - should also be moderately allowed as their Glycaemic Index is less than bread. However no sugar should be added. It will be more practicable to add some vegetable like Tomato while preparing fruit juice that will decrease G.I. and increase nutrient value.
It is important to note that fruits contain very important fibres, soluble prebiotics and insoluble, have a good satiety value, contains anti-cancer and anti-oxidants, soothens the G.I. tract, removes toxins, and decrease bad cholesterol. At present fruits are strictly restricted by most of the consultants and dieticians.
- Fats - Restricted amount of “Ghee” should be used as it has better omega 6/3 ratio increase gastric emptying time and hence decreases G. Index of given food. It has got good satiety value. For other vegetable oils, there should be restriction. Dalda and margarines should be avoided better (All bakery products contains Hydrogenated fats). Food should be cooked and then ghee should be added. Coconut oil is having better omega 6/3 ratio.
- It is very important to note that food with high Glycaemic Index are devoid of Nutrients, vitamins, anti-oxidants etc. While food with lower glycaemic indices will have those.
- Refined foods and highly milled foods will be slower to move (sticks to the gut in common language) and will require more water to flush out hence will be load an water - Elecrolyte Balance and Kidney.
It is very much surprising that above observations are all known to age-old “Ayurvedas”. Dr. Amdekar our legendary paediatrician and great teacher say that we know very little about Diet, my grand mother was knowing better than me.
I am very grateful to Miss Nishita Shah, Consulting Dietician, National Hospital, Borivali, for providing me literature, reference and guidance. Librarian - P.D. Hinduja Hospital, for allowing me for references. Dr. Ramji Shah - Ayurvedic Practitioner, Vasai. Raheja Hospitals - for their yearly CME classes in Diabetes Management.
CJ Parmar*, Urmila C Parmar*,
Hardik K Shah**
*Senior General Practitioner, Bhayandar (West); **Presently Department of Nephrology, Bombay Hospital and Research Center, Mumbai 400 020.
1. Glycemic Index - by Dr. Neeta Kumar and Others from (All India Medical Sciences) New Delhi - in Drug index. Jan-March 2006.