‘A true doctor first tries to treat the disease by food; only when food fails does he prescribe medicines.’ This excellent advice given by Sun Semiao, an early Chinese medical writer of the 6th century, holds good in the treatment of diabetes even today.
Diet is the single most important factor in the successful treatment of diabetes. In spite of all the advances in the field of medical treatment, diet has maintained its supremacy. If faulty dietary habits are persisted with, drugs cannot help. Besides, for obese diabetics, a dietary change is the only treatment of choice.
Principles of diet-planning:
A diabetic’s diet should be such as would
- supply in sufficient amounts, energy-giving nutrients like carbohydrates, proteins and fats,
- supply in sufficient amounts, vitamins and minerals which are necessary for the body and for the control of diabetes,
- supply enough calories (nutrition) to the body to attain or maintain ideal body-weight,
- help in avoiding or controlling complications of diabetes.
Total quantity of food : It is generally agreed that during the course of a day, a diabetic should be given food that would supply about 30 calories per ideal body-weight. However, whether the diabetic has to do a manual or a sedentary job and whether he is overweight or underweight should be considered while deciding the whole-day rationing of food.
A diet supplying 1500 to 1800 calories during the day would be sufficient for a middle-aged and sedentary diabetic.
However, developing children, pregnant women, breastfeeding mothers and sportsmen would need more food.
The total food should be consumed in four or five almost equal parts during the day. Many diabetics commit the mistake of taking only two meals a day. Naturally, such meals are heavy. The insulin produced in the body (or that injected as a medicine) is insufficient to metabolise this excessive food. Hence the blood sugar level rises. On the other hand, at a time midway between two meals, the glucose level drops down abnormally. Such wide fluctuations of blood-glucose levels are undesirable. Besides, if the blood-glucose concentration drops down too much, it may lead to a hypoglycemic coma, a critical condition. It is therefore advisable for the diabetic to have 4 to 5 small meals equally spaced out during the day.
How the total allowance of calories should be obtained in parts has been suggested below:
About 20 % of the total calories through the morning breakfast,
About 40 % of the total calories through the lunch,
About 10% of the total calories through the afternoon tea-coffee and snacks,
About 20 % of the total calories through the dinner,
The rest 10% of the total calories through late evening milk and snacks/fruits.
The diet : ‘What type of diet should a diabetic take?’ is an important question which calls for a detailed answer.
It is a sad fact that a diabetic does not get adequate guidance about food. Most advices about diet are limited to prohibiting or curtailing the use of refined sugar, jaggery, rice, potatoes and fried eatables. In fact, besides the things to be avoided, a diabetic should also be supplied with a list of things to be eaten, the right amounts of those foods and the proper timings for taking those foods. Half knowledge does more harm than good to the diabetic because apart from the prohibited 4 or 5 items of food, he continues to eat everything else, thereby inviting a rise in blood-glucose level.
Some diabetics, heeding to the advice of their relatives or friends, observe fasts or opt for fad diets consisting of one or two food articles (e.g., chapaties and cooked karela; chapaties and leafy vegetables, etc.). This gradually leads to depletion of vitamins and minerals stored in the body and gives rise to symptoms of their deficiency. Besides, sooner or later, the tongue rebels against such monotonous diet.Ultimately the diabetic develops such aversion to dieting that he reverts to old faulty food-habits with a vengeance. In fact, a diabetic can choose his diet from a variety of food-articles. He need not stay away from the tastes he likes. Similarly he need not consume diet which is entirely different from that prepared for the rest of his family. Wheat, rice or bajri are similar in their nutrient contents. Likewise most vegetables have similar nutrients. Thus there is no reason why a diabetic should eat the same cereal or the same vegetable day after day.
The major constituents of the food we eat are: carbohydrates, proteins, fats, vitamins, minerals and fibres (roughage). To maintain health and to aid the various processes occurring in the body, it is essential that all these constituents are obtained in sufficient amount.
Carbohydrates include sugar and starch. Cereals are their main sources. Refined sugar, jaggery, honey, etc. are concentrated forms of carbohydrates. One gram of carbohydrates provides energy worth 4 calories to the body.
Proteins are essential for the growth of the body and regeneration of cells lost due to wear and tear. Milk, pulses, meat, fish and eggs are their main sources. One gram of protein provides energy worth 4 calories to the body.
Fats are available from ghee and oils. There are two types of fat : saturated and unsaturated. Saturated fats are believed to be the causes of narrowing and hardening of arteries (atherosclerosis). Atherosclerosis ultimately leads to a heart attack or cerebral haemorrhage. It is therefore desirable to drastically cut down the consumption of food articles containing saturated fats. Butter, ghee, vegetable ghee, coconut oil and palm oil have lots of saturated fats. Meat,fish and eggs too are rich in saturated fats. On the other hand, groundnut oil, til oil, corn oil, soyabean oil, linseed oil and cotton seed oil are sources of relatively harmless, unsaturated fats. Each gram of fat provides energy worth 9 calories to the body.
Vitamins and minerals are extremely important nutrients which serve numerous functions inside the body. Raw vegetables, fruits, germinated pulses and germinated cereals are excellent sources of vitamins and minerals.
During the past 60-65 years the notions about the proportions of carbohydrates, proteins and fats in a diabetic diet have undergone a radical change.
Uptil the second decade of this century, diabetics were advised to consume a very low-carbohydrate and very highfat diet. But gradually it became known that a high-fat diet ruins the blood vessels and harms the heart. Besides, no logical reason could be put forward for carbohydraterestriction. Modern dieticians and physicians recommend, for the diabetics, a diet 55 to 60 percent of which is comprised of carbohydrates, 20 to 22 percent of fats and 18 – 20 percent of proteins.
It is now unanimously agreed that a diabetic should receive a larger than usual quota of vitamins and minerals.
It was mentioned that some researchers have propounded the ‘Vit B6 deficiency and diabetes’ theory. According to their view, lack of vitamin B6 raises the xanthurenic acid content of the blood, which in turn damages the pancreas and leads to diabetes. A fact which supports this belief is that all diabetics excrete large amounts of xanthurenic acid in their urine. If diabetics are given 50 mg of vitamin B6 every day, urinary xanthurenic acid rapidly diminishes and symptoms of diabetes begin to disappear. Dr. Rosen has recommended that every diabetic should be given at least 10 mg of vitamin B6 daily.
Magnesium has been found to bring down the requirements of vitamin B6 by decreasing the xanthurenic content of the body. Dieticians suggest that every diabetic should receive 500 mg of magnesium daily.
Some researchers claim that Vitamin C, Vitamin B1 and panthothenic acid are helpful to diabetics because, like sulphonurea drugs, they stimulate the pancreas to produce more insulin. Again, animals kept on a totally ‘Vitamin C-free’ diet manufacture less insulin in their bodies and develop symptoms similar to those of diabetes.
It has been seen that diabetics given 300 to 600 units of vitamin E daily, many a time require much smaller doses of medicinal insulin.
Chemical analysis has also shown that diabetics suffer from a vitamin A deficiency. Experiments have shown that when diabetics are daily given about 15000 to 16000 units of vitamin A, their health improves and the concentration of cholesterol in their blood falls.
Chromium is also a very important mineral for diabetics. If there is chromium deficiency in the body, the effectivity of insulin decreases. If experimental animals are made chromium deficient, their blood-glucose and bloodcholesterol levels rise.
In short, a diabetic’s requirements of vitamins and minerals are much greater than normal. The natural sources of these vitamins and minerals have been enlisted in the appendices given at the end of this book. Besides, if a need arises, these vitamins and minerals can be obtained through pills as well.
It is desirable that the fibre-content of our diet is high. People or tribes who give fibre-containing food articles a due place in their diet, almost always succeed in keeping diabetes and other diseases at bay. Africans are living proofs of this fact.
If a diet is rich in fibres, the absorption of glucose through the intestines is slowed down. Consequently the blood-sugar level rises gradually. The pancreas gland is able to cope with such a situation very easily. Dr. James Anderson of Cantucky University has proved through experiments that when diabetics are given a high-fibre diet, their medicinal insulin requirements are reduced by almost 25 percent. Vegetables, fruits, whole cereals and whole pulses are excellent sources of fibres. By removing bran from the flour, by eating polished rice, by keeping away from fruits-vegetables and by consuming processed, refined and soft foods, we invite not only diabetes but also other diseases, right from constipation to cancer.
Daily diet-plan : On the basis of the abovesaid facts, a diet for the whole day can easily be planned.
Of the total 1500 to 1800 calories
- 900 to 1075 calories should be obtained through carbohydrates. For this the amount of carbohydrates required will be 225 to 275 gms.
- 325 to 400 calories should be obtained through fats. For this the amount of fats required will be 35 to 45 gms.
- 275 to 325 calories should be obtained through proteins. For this the amount of proteins required will be 10 to 80 gms.
The carbohydrate, fat and protein-contents of various foods have been enlisted in appendices given at the end of the book.
At the outset, a diabetic should first clearly understand what foods he can take freely, what foods should be taken in moderation and what foods should be totally avoided. The following list will guide him in this respect:
Prohibited foods : Sugar, glucose, honey, jam, chocolates, sweets, sweet drinks, sweetened milk, canned fruits, sweet biscuits, cakes, pie, pudding, peppermint and alcohol.
Foods to be taken in moderation : Cereals, pulses, potatoes, peas, dry fruits, cheese, milk, butter, ghee, oil, meat, eggs, fish.
food that can be taken as desired : Most fruits, vegetables, drinks (tea, coffee, etc. sweetened with sachharine).
Classification of foods:
Foods can be divided into eight categories:
(1) Vegetables (Type A) : e.g., cabbage, cauli flower, cucumber, brinjals, karelas, ladies fingers, tomatoes, raddish, chillies etc.
The carbohydrate-content of these vegetables is very low. Such vegetables can be taken as much as desired in the raw form; however they should not be consumed more than a cupful if cooked.
(2) Vegetables (Type B) : e.g., carrots, onion, green peas, beet, raw mangoes, etc.
Every 100 gms (½ cup) of these vegetables have 7 gms of carbohydrates and 2 gms of proteins (totally 36 calories).
(3) Fruits : The following fruits, when consumed in quantities mentioned alongside, supply 10 gms of carbohydrates (i.e., 40 calories) :
(4) Cereals : When consumed in the specified quantities, the following cereals supply 15 gms of carbohydrates and 2 gms proteins (totally 68 calories) :
Jowar, bajra or wheat flour – 2½ tablespoons (20 gms); khichri or boiled rice ½ cup (100 gms); non-sweet biscuits (20 gms); boiled potatoes – 2 (100 gms); sweet potatoes ¼ cup (50 gms).
(5) Pulses : Generally, 1 small container (katori or wati) of any cooked pulse supplies 125 to 140 calories.
(6) Fats : Approximate 45 calories are obtained from : Butter, ghee or oil – 1 teaspoon (5 gms)
Cashewnuts, almonds, groundnuts – 10 gms
(7) Milk : 1 cup of milk or curd supplies 12 gms of carbohydrates, 8 gms of proteins and 10 gms of fat (totally 170 calories). A reduction of 40 calories can be achieved by removing fat from the milk.
(8) Non-vegetarian foods : 30 gms of meat or fish or 1 (50 gm) egg supply 7 gm protein and 5 gm fats (totally 80 calories).
Given below is a model diet (1500-1600 calories) for the whole day, formulated on the basis of the above facts:
- Early morning : 1 cup of non-sweetened milk, 1 cup of tea or coffee (with sachharine), 1 slice of bread or 2 puries or 2 khakras or 1 idli.
- Mid-morning : 1 cup of buttermilk or some fruit.
- Lunch : 2 small chapaties (with 1 teaspoon ghee), 1 cup of cooked vegetable, 1 cup of dal (cooked pulse), Salad of raw ‘type A’ vegetables, 1 cup of buttermilk or curd.
- Afternoon : 1 cup tea or coffee (with sachharine), 2 slices of bread or 2-3 non-sweet biscuits.
- Dinner : 1 ‘cup of boiled rice or khichri (with 1 teaspoon ghee), 1 cup of dal or curry (flour-free), 1 cup of cooked vegetable, Salad of raw ‘type A’ vegetables, 1 cup butter milk or curd.
- Before retiring : 3/4 to 1 cup of non-sweetened milk.
- Developing children, pregnant women or manual workers may need more food; obese persons should consume less food.
- Non-vegetarians can have an egg-omlette in the breakfast or meat (or fish) in a meal; but they should cut down the amount of other foods proportionately.
- Tables for food-substitution (which foods can be had instead of a particular food) have been given at the end of the book.
- Considering the fact that the size of chapaties or containers (katori or wati) is different in different homes, a diabetic should initially (for a few days) weigh his diet, to make certain that he does not exceed stipulated calories.
Sweetening agents to be used instead of sugar : Such sweetening agents include sachharine, fructose and sorbitol. Of these, sachharine is preferable since it has no nutritional value. It is about 350 times sweeter than sugar. It is available in the market in tablet or liquid forms. It should be noted that sachharine should not be added to food while cooking because extreme heat disintegrates it to create a very disagreeable and bitter taste. It should be added to foods after they have been cooked and while they are cooling.
Alcohol : Alcohol is a social menace. It variously harms the diabetic:
- It suddenly brings down the blood-sugar level, more so in those diabetics who take oral hypoglycemic drugs. A very low blood-sugar level may cause unconsciousness (hypoglycemic coma), a critical condition calling for urgent steps. Unfortunately, however, such unconscious persons get no attention because people think that he has collapsed due to excessive alcohol intake.
- It harms the liver.
- It stimulates the appetite and leads to obesity, whose connection with diabetes is well-known.
Some practical suggestions regarding diet :
- Diet control is extremely important and indispensable for diabetics. No drug can compensate for or undo the harm caused by faulty and reckless diet. Diet should be planned intelligently and on the basis of scientific principles. If due to false beliefs or misleading advices from relatives and neighbours, you are observing fasts or eating monotonous diet (e.g., chapaties and cooked karela) day after day, stop such practice immediately. A diet without variety not only arouses a feeling of dislike in the mind but also causes harm to the body. Always keep in the mind that for a diabetic, diet-control is not a temporary or passing phase but a life-long responsibility. Therefore give variety its due place in your diet. Use spices (in moderation though) because they possess no calorific value. Albeit, restrict the use of salt.
- Maintain the timings of your meals meticulously. If this is not done, it is well-nigh impossible to maintain the blood-sugar at normal levels all the time.
- However busy or occupied you may be, never miss a meal. This is necessary to prevent low blood-sugar.
- Be on your alert about correct and incorrect foods even when you go to hotels, parties or visit your relatives. Always keep sachharine tablets with you.
- While on a tour to some distant place, keep handy fruits like apple, orange or sweet lime. This will help in case symptoms of low blood-sugar arise.
- Even if you do not have an appetite, do not abstain from food during an illness. Have light food of your liking at fixed timings.
- It is on the basis of the amount of your food in-take that your doctor has prescribed the dose of anti-diabetic drugs. Therefore do not vary the total amount of food you take during the day.