Selecting diets when you are a diabetic

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Good advice by Dr. Harold

Non- diabetics can eat a multitude variety of foods without selection, but when you are a diabetic there are known restrictions you need to follow to keep your blood sugar within the normal range. In brief, the aim of diabetic treatment is to bring blood sugar (glucose) as close to normal ranges as possible through dietetic and other regimes.

During fasting, when you have not eaten any food overnight, should read 70-99 mg/dl (3.9-5.5 mmol/K) This would be the ranges for non-diabetics. Diabetics should not attempt to reach such low levels, as the chances of going into ‘hypoglycaemia’ may be high. On an average a diabetic should keep the fasting sugar at about 110mg/dl or between 80-130mg/dl (4.4-7.2 mmol/L). If your fasting level is above 126mg/dl falls into the category of a ‘pre-diabetic’.

When you plan a diabetic diet, you need to consider the calorie content of each ingredient to get a handle on your weight and feel better, as well. So, in short you need to watch your portion sizes and calories.

There are certain foods high in fat and added sugar you need to avoid, such as sweets, ice cream, puddings, sugar drinks and most fatty food. Also, it is advisable to restrict your salt intake in your cooked foods.

Let’s discuss the staple diet of the Sri Lankans living in Sri Lanka and expats living in other countries. Eating white rice seems to be popular for lunch and dinner, because of its colour, flavour, easy cooking, and easily converted to more palatable dishes like fried rice and so on. Though it is a versatile grain, cheap and easy to cook, contains too much of starchy calories not well recommended for diabetics. In fact, one cup of cooked white rice contains around 240 starchy calories that gets converted into fat in the body, if they are not burnt off.

Sales in supermarkets of polished white rice is much greater than more healthy and
nutritious red or brown rice, in Sri Lanka.

White rice being minus the outer bran and being polished gets absorbed much quicker than the unprocessed brown or red rice. This causes a problem among diabetics. Being absorbed fast through the gut as glucose, may rapidly increase glucose levels in the blood and even cause spikes. You tend to get hungry sooner than consuming the unprocessed varieties of rice. Further, micro- nutrient content is much less.

Diabetics should avoid white processed rice and always consume unprocessed rice for more glucose control, slower absorption and less spiking.

Resistant rice: You still could enjoy white rice being a diabetic by making the rice grain more resistant to digestion and absorption. This process is naturally created when you enjoy your plate of biriyani lumprai, fried, or pilau styled rice.

It does not mean that you should eat rice cooked in above methods daily, due to the high fat and calorie content. You could make your plain rice more resistant for your daily eating.

Researchers in Sri Lanka discovered a new simple way of cooking the white grain to dramatically cutting down its calories by as much as 50 per cent and offer some health benefits.

All you need to do is to add a table spoon of coconut oil into the boiling water before adding your raw rice. Sudhair James, an undergraduate chemistry student from the College of Chemical Sciences in Sri Lanka, who led the research with his supervisor explained this new method of cooking rice. He presented the work at the National Meeting and Exposition of the American Chemical Society on Monday.

The rice after cooked by this method is left to cool overnight in the refrigerator, and next day you microwave to warm the rice and enjoy the fluffy white rice.

The advantage of consuming resistant rice is that our bodies cannot brake down into glucose to be absorbed and increase blood sugar levels. They pass through the large bowel where they act as more like a dietary fibre and provide benefits to the gut microbiota.
This method of producing resistant starch also applies to pasta, too.

You could also try low carb diets which limits your carb content, like Atkins or South Beach diets. In these diets the carb content is reduced to about 40 grams, which means you could still enjoy two table spoons of starchy rice per meal. The rest of the calories are obtained from veggies, fish and meat. These diets are specifically designed to lose weight and not for diabetics. Research on the benefits of low-carb diets for type 2 diabetes is still mixed.

One of the best diets recommended for diabetics is the Mediterranean diet. It is a heart-healthy diet using lots of fruits and veggies, fish chicken, nuts and olive oil, legumes and whole grain.

There is a popular diet for diabetics called the “Zone Diet”. In this diet you keep your blood sugar very low stable levels. (40% carbs, 30% protein, and 30% fat). The food you eat in these diets are selected according to the glycaemic index.

People living in Sri Lanka cannot afford to eat specially labelled diets, and for them rice and curry is the cheapest and most energy producing diet, especially to the out-door working class of people.

Today, diabetes is not uncommon among the poorer class of wage earners, though it
was known as a ‘rich-man’s disease’.

The low wage earners find it difficult to test their glucose levels frequently, as they cannot spend about rupees 5000 to purchase a glucometer and each testing strip costs approximately Rs. 80.00.

Visiting diabetic clinics run by the state cannot cope up with the number of diabetics arriving at the respective clinics and may have to spend hours, affecting their job situations.

Due to their inability to control their blood sugars, the public hospitals are full of them with complications, even needing amputations of limbs.

The richer folk gets diabetes due to over-indulgence, eating too much of rich high carb food, stress factors, and obesity.

They need to do 10,000 steps walk daily, reduce their carb content and alcohol use. Low sugar veggies and fruits: Low sugar vegies include Brussels sprouts and other cruciferous vegies like broccoli, cauliflower. Other low sugar vegies are: cucumber, kale, carrots, green beans, spinach, rocket, arugula lettuce, tomatoes and radishes.

For a diabetic, fresh or frozen vegie are preferable to canned vegies because of added salt. Choose low salt canned vegies instead. Another factor you need to investigate is those complex carbs containing high fiber.

Such vegies take a long time to digest, absorption is slower and blood sugar does not spike. The University of Texas Southwestern Medical Centre found in a study that people who boosted fiber consumption from 24 to 50 grams per day showed drops in their blood sugar levels. The researchers found that, for some, changing to a high-fiber diet worked as well as some medications for diabetes Whole plant foods are great sources of complex carbohydrates: such as Green vegetables: whole grains and foods made from them, such as oatmeal, pasta, and whole-grain breads: starchy vegetables such as, sweet potatoes, corn, and pumpkin: Beans, lentils, and peas.

Foods that are high in carbs are: pastries, breads, rice and potatoes

Fruits which are low in sugar include all varieties of berries, mushrooms. Carambola fruit also provides amazing health benefits. It is very low in calories, only 31 in 100g, and is high in antioxidants, vitamins C and B, riboflavin, folate, niacin and minerals such as calcium, manganese, iron, zinc, and potassium. Studies have found it also control diabetes and lowers cholesterol.

Fruits that contain large amounts of sugar should be avoided. A medium sized ripe banana contains 14.4 grams of sugar almost double the amount in a ½ cup of blue berries. Now you know why blue berries don’t taste much in when added to your oatsmeal breakfast. Apples though having high sugar- 18.9 grams in a medium apple are high in quercetin, a nutrient that reduces the risk of diabetes and heart disease and stabilizes blood sugar levels. Raspberries have 2.7 grams of sugar per ½ cup serving.

Strawberries have about 3.5 grams of sugar per half a cup. In brief, all berries have low blood sugar and you should eat much of them, also having antioxidant, flavones and other nutrients.

Fruits that have high fructose are pineapples (16 grams), Oranges (17 grams), Grapes over 20 grams, and mangoes.

Most diabetics feel that fruits are nutritious and good for diabetes and they eat with no concerns about their fructose levels, affecting their blood sugar numbers. All fruits have sugar in the form of fructose and sucrose. Too much of fructose can harm you and even linked to increase belly fat, slows metabolism and gains weight and worst can cause a non-alcohol fatty liver.

Goals:
1. Eat a well-balanced low carb diet, emphasizing fruits, vegetables, whole grains and
lean protein, while watching total calories and getting exercise regularly.

2. Eat more vegetable products and fewer animal products.

3. Eat more fresh and homemade foods and fewer processed foods. Avoid fast food and junk food. You know what they are.

4. Choose your fats wisely. Cut down on meat, the skin of poultry, whole-fat dairy products, stick margarine, fried foods, processed snack foods, and commercial baked goods made with trans fats. Think about dressings, sauces, and cooking oil. Use olive or canola oil to cook whenever possible and moisten your bread with olive oil or soft margarine. Get “good fats” from fish and nuts.

5. Choose your carbs wisely. Cut down on simple sugars; remember that sodas, sports energy drinks, and fruit juices are loaded with sugar. Cut down on highly refined products made with white flour. Favor whole-grain, coarsely ground, unrefined products. Don’t be fooled by dark-colored bread or by labels that boast of unbleached flour, wheat grain, or multigrain flour. Instead, look for whole grain as the first ingredient, and read the fine print to learn the fiber content of a portion; more is better.  Learn to like bran cereal, vegetables, fruits, nuts, and seeds. Consider fiber supplements if you can’t get enough from foods.

6. Eat more potassium-rich foods, such as citrus fruits, bananas, and other fruits and vegetables. Eat more calcium-rich foods such as low-fat dairy products, broccoli, spinach, and tofu (but don’t take calcium supplements to boost your daily intake above 1,200 mg).

7. Eat more grain products, especially whole-grain products, aiming for at least 6 ounces a day. Count 1 cup of dry cereal; ½ cup of cooked cereal, rice, or pasta; or one slice of bread as 1 ounce. Whole grains and brown rice should provide at least half your grains; the more, the better.

Hope this article will help you to control your diabetes and for a healthier fruitful life.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery.
Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the
International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International
Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the
American Academy of Aesthetic & Restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery
(Cey). Government scholar to UK for higher studies and training.

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