Good carbs, Bad carbs

We all are aware about the silent killer sneaking around the corner. Diabetes mellitus starts insidiously, with a few initial symptoms that are mostly overlooked by the patients. WHO has been highlighting the health risk associated with diabetes in no uncertain terms.

The statistics from India are equally alarming. The disease was diagnosed in 9.3 per cent senior citizens living in India's rural areas, according to a recent study by the Union Ministry of Family and Health Welfare (MoFHW) published on January 6, 2021.

India is currently called the ‘diabetes capital’ of the world. Diabetes not only affects the ‘quality of life index’ of individuals and the family, it imposes a significant burden on the health infrastructure of the country.

Diabetes Type 2 – the one that can be prevented - accounts for around 90% of all diabetes worldwide

To understand ways to prevent diabetes, one needs to understand the root cause of the disease.

Most misunderstood causative factor of diabetes is the role of sugar.

Sadly enough it’s only dietary sugar that’s thought to be the culprit, when in reality diabetes is a disease characterised by abnormal glucose in the blood. And this glucose is derived from breakdown of all foods that we consume,especially carbohydrates. Add our modern dietary habits which mainly consists of refined carbohydrates i.e maida based pizzas, pastas, take-aways and ready to eats…… we are preparing to be a part of the above statistical data!!! Mind you, wheat or whole wheat is no friend of ours, for it’s ultimately a carbohydrate.

There is a famous Ayurvedic saying

“When diet is wrong, medicine is of no use; When diet is correct, medicine is of no need.”

Here, diet doesn’t mean starving oneself to lose the kilos, it’s the concept of a balanced diet. For adults, calorie intake should match the daily requirements. And most importantly consume foods that release glucose slowly in the bloodstream, better explained by the concept of glycemic index and glycemic load.

The glycemic index (GI) is a food rating system created by Dr. Jenkins at the University of Toronto in 1981. It rates individual foods on a scale of 1-100 based on how drastically those foods make your blood sugar rise. The lower a food's glycemic index, the slower blood sugar rises after eating that food. In general, the more processed a food is, the higher its GI, and the more fiber or fat in a food, the lower its GI.

In simple words,

GI is a measure of how quickly a food causes our blood sugar levels to rise.

That’s just a part of the story though.
To understand a food's complete effect on blood sugar, you need to know both how quickly it makes glucose enter the bloodstream and how much glucose per serving it can deliver.

A separate measure called the glycemic load does both — which gives you a more accurate picture of a food's real-life impact on your blood sugar.

Watermelon, for example, has a high glycemic index (80). But a serving of watermelon has so little carbohydrate that its glycemic load is only 5.

How does GI matter?

• low GI of a food item means smaller rise in blood glucose after meal
• Low GI diet can help people lose weight
• Low GI diets can improve the body’s sensitivity to insulin resistance, thus improving diabetes control.
• Low GI foods can prolong physical endurance
  

High GI foods do have a role to play in our diet. For e.g. they help refuel carbohydrate stores after exercise.

Factors that affect glycemic index -

• Foods that contain fat and protein such as milk and legumes have low GI
• Increasing your protein intake helps you feel full for longer, increases your metabolism (helping with weight loss) and helps to maintain your lean muscle mass. Protein also increase’s your brain’s levels of ghrelin, the hunger hormone that tells you when your belly is full.
• High fibre foods such as rolled oats, beans, lentils have low GI.
• When a food is processed or cooked,the structure of the starch changes and granules become swollen.less gelatinised starch is digested slower resulting in lower GI
• Addition of lemon juice and vinegar lowers GI as acids in foods slows down the rate of digestion and absorption.
• Stone ground flours have lower GI than refined white flours.
• Absolute no to skipping meals- leads to greater fluctuations in blood sugar levels increasing the cravings for high GI sugary foods.

Why bother so much though?

The effects are thus-

• Non diabetics/ pre-diabetics : fluctuations in sugar levels cause binge eating/ frequent hunger pangs.
• Diabetics: fluctuations in blood sugar levels leading to inadequate control of diabetes; frequent changes in medicines required; long term damage to other organ systems i.e heart/kidneys/ eyes/ and propensity to develop frequent infections and severe diseases like stroke.

Add to that - obesity, hormonal imbalance, loss of productivity and risk of developing other non communicable diseases like hypertension, cancer etc.

Covid-19 and diabetes

Covid-19 has been absolutely unforgiving and an unhealthy lifestyle is punished immediately. Complications are more frequent in pre-diabetics and diabetics. Patients with impaired blood glucose tolerance (pre-diabetics) end up with long term diabetes while those on oral medications end up requiring long term insulin, similarly those patients who are already on insulin therapy discover that their insulin requirements have shot up. The dreaded black fungus is the worst outcome (other than loss of life) that diabetics may end up with.

Covid-19 has brought home an unambiguous message - shape up!

If all the technical talks have baffled you, here’s my simple mantra to be followed in everyday life.

• Do not eat less, eat right
• Balanced diet - vegetables and fruits that must form about half of our plate serving since vegetables and fruits are the healthiest foods to eat. The rest of the food plate serving should contain proteins and grains, especially ancient grains like millets, quinoa, Jowar, bajra, rice without starch.
• Try to include at least one low GI food in each meal.
• Limit the amount of processed, refined starch foods, as they tend to be low in fibre and other nutrients and have a higher GI.
• Minimise consumption of ready to eat and take away foods
• Avoid refined sugars

• Sleep well everyday: Inadequate sleep can cause a 40% drop in sensitivity to insulin, which increases the risk of weight gain and diabetes. Also leads to greater blood sugar fluctuations. Not to forget cravings for comfort food
• Exercise : increases the utilisation of glucose by muscles, thus helping maintain blood glucose levels
• Check for vit B12 and vit D levels annually. Very important to maintain robust metabolism of the body.

To summarise - Diabetes control is not just sugar control. It’s maintaining normoglycemia in the body. It’s about leading a holistic lifestyle and consuming wholesome foods. It’s about going back to our roots and following what our grandmas did!!!

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