Written by Ankita Upadhyay
Sheila Verma, 55, had a long-standing battle with Type 2 diabetes, a particularly stubborn kind that required her to be conscious of her diet despite combination therapies. Then she worked with her dietician and changed her food habits. She switched to non-starchy vegetables, incorporating cabbage soup, carrot, cauliflower and mushroom as curries or boiled mixes, and liberally using onions, broccoli and asparagus in her cucumber salads. All of these contain fewer carbohydrates, enough to meet her body requirements and have a low sugar load. Yet they were effective in keeping her hunger at bay, curbing her cravings and providing a nourishing supply of minerals, fibre, vitamins and phytochemicals (disease preventive substances). Sticking to this plan has helped her keep sugar levels within limits.
Increasingly, researchers are finding out that reducing overall carbohydrate intake and eating more non-starchy vegetables and whole foods can help improve health outcomes for people with diabetes. At the recent Cardiometabolic Health Congress, Alison Evert, manager of the nutrition and diabetes education programmes at the University of Washington Neighbourhood Clinics, said there are multiple types of eating patterns recommended for people with diabetes, “but approaches that target glucose, weight management and cardiovascular risk reduction through changes in both quantity and quality of carbohydrates may have the most therapeutic advantages.”
News reports quoted her as saying that providers should focus on “reducing carbohydrate intake in people with diabetes by cutting out sugar-sweetened beverages and reducing the portion sizes of starchy foods, as well as improve carbohydrate quality by creating an eating pattern featuring more non-starchy vegetables and whole foods, and less added sugars and refined grains.”
Reacting to the new findings, Dr Anupam Biswas, Consultant Endocrinologist at Fortis Hospital, Noida, feels that the ideal amount of carbohydrate intake for people with diabetes is still inconclusive as they work differently for different people. “Although monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrates are key for improving post-prandial glucose management, the literature concerning glycaemic index and glycaemic load in individuals with diabetes is complex, often with varying definitions of low and high glycaemic index food,” he said. The glycaemic index ranks carbohydrate food on their post-prandial glycaemic response and glycaemic load takes into account both the glycaemic index of food and the amount of carbohydrate eaten.
“Studies have found mixed results regarding the effects of glycaemic index and glycaemic load on fasting glucose level and HbA1c, a simple blood test that measures your average blood sugar levels over the last three months. One systematic review found no significant impact on A1C while two others demonstrated A1C deduction of .15% to .5%. Reducing overall carbohydrate intake for individuals with diabetes has demonstrated evidence for improving glycaemia and may be applied in a variety of eating patterns that meet individual needs and preferences for people with Type 2 diabetes. Low carbohydrate and very low carbohydrate eating patterns in particular have been found to reduce A1C and the need for antihyperglycemic medication,” he added.
Dr Sandeep Kharb, Senior Consultant Endocrinologist at Asian Hospital in Faridabad, says that a more comprehensive diet including fibre content is beneficial for diabetics. “Cabbage, cauliflowers, spinach, legumes, nuts contain carbs but in lower counts. Besides, they contain fibre as well,” he added. He asks most of his diabetic patients to use less refined carbs such as semolina. “The consumption of sugar, sweetened beverages and processed food products with high amounts of refined green and added sugar is not advisable as it can displace healthier, more nutrient dense food choices,” says Dr Kharb.
Dr Biswas says that the systematic reviews and meta analysis of Randomised Controlled Trials, (RCT) found carbohydrate restricted eating patterns, particularly those considered low carbohydrate, were less than 26 per cent of total energy. These were effective in reducing A1C in the short-term. “Part of the challenge in interpreting low carbohydrate research has been due to a wide range of definitions of a low carbohydrate eating plan. Weight reduction was also a goal in many low carbohydrate studies, which further complicates evaluating the distinct contribution of the eating pattern,” he says.
It is important to reassess the individualised meal plan guidance regularly for those interested in this approach. Providers should maintain consistent, medical oversight and recognise that insulin and other diabetes medication may need to be adjusted to prevent hypoglycaemia. “In addition, very low carbohydrate eating plans are not currently recommended for women who are pregnant or lactating, children, people who have renal disease or people with or at risk for disordered eating. This plan should be used with caution in those taking SGLT2 inhibitors because of the potential risk of ketoacidosis. Regular intake of sufficient dietary fibre is associated with lower all-cause mortality in people with diabetes and prospective cohorts,” Dr Biswas added.
In fact, the US-based National Library of Medicine studies have found plant-based diets, that emphasize legumes, whole grains, vegetables, fruits, nuts and seeds and discourage most or all animal products, as effective. “Cohort studies strongly support the role of plant-based diets, and food and nutrient components of plant-based diets, in reducing the risk of type 2 diabetes. Evidence from observational and interventional studies demonstrates the benefits of plant-based diets in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications. Optimal macronutrient ratios for preventing and treating Type 2 diabetes are controversial; the focus should instead be on eating patterns and actual foods. However, the evidence does suggest that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play a major role in the prevention and management of Type 2 diabetes.”
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