Blood Sugar and Cholesterol, weight and Blood pressure all are related to the food we eat. Diet plays a very special role in controlling the levels of many of the harmful substance in the blood and our body and in preventing the debilitating complications of Diabetes.
Appropriate diet is possible only with good knowledge about our food products- what do they contain and how it affects our body. This and a lot more in the coming sections on food and diabetes.....
Fats are an essential component of our food. Simply said, fats are like rocket fuel for our body- concentrated source of energy - the calories contained in 1 gm of fat is 9 Kcals as compared to 4 Kcals in 1 gm of protein or carbohydrates, 2 tbspns of cooking oil gives approx 240 kcals that is just enough energy required to almost boil 1/2 a cup of water !!!
After being broken down to their basic units ( fatty acids) they provide energy to the working muscles of heart, arms and legs to perform work. Fats are stored in special fat storage cells called adipocytes- they not only store fats but also secrete some hormones both good and bad for our body.These may regulate our appetite, weight, mood condition of our blood vessels including many things.
Fats are required for many other purposes
Fats form external linings or paddings around internals organs to provide lubrication and insulation.
Some essential vitamins can be transported only with help of fats in the blood.
Fats make the backbone of many hormones secreted in the body which is very important for proper functioning of the body
Fats are very important for healthy skin
Visible & Invisible Fats
Depending on their external apearence fats are divided into visible & Invisible Fats
Visible fats are the obvious and familiar, with oily smooth texture like in cooking oils, butter, clarified butter, vegetable shortening, cheese, cream, Lard etc.
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Invisible fats are not apparently identifiable from their texture or taste- these are cereals, pulses, nuts, seeds, milk, meat eggs, fish, vegetables- but they still contain fats.
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Important for Diabetics
Excessive consumption of invisible fats in nuts, seeds, meat and poultry may lead to high cholesterol and Triglyceride levels which may be harmful for Diabetics
Fats & our Body
Since blood is 95% Water, and fats are oily- as we all know water and oil do not mix, similarly fats also cannot be transported in blood as such, for this purpose they form complexes with proteins- which are called Lipoproteins, or Glycerol which are called Triglycerides and thus become soluble in blood and transported to all parts of the body.
HDL & LDL
Their are 2 main types of Lipoproteins High Density Lipoproteins ( HDL) & Low Density Lipoproteins ( LDL)
HDL is the so called 'Good or Cholesterol'- it has a protective effect on the blood vessels and prevents the formation of plaques or blockages in the arteries which may lead to Heart attacks, Stroke and other diseases of blood vessels.
LDL is the so called 'Bad Cholesterol' it is harmful for the body if in excess-it promotes the formation of atherosclerotic plaques and blockages leading to heart attack, stroke, peripheral vascular disease etc.
Triglycerides
High levels of triglycerides also help in formation of plaques and as well as pancreatitis which may further complicate Diabetes.
Important for Diabetics
In most Diabetics HDL may be decreased and LDL & Triglycerides increased, it is important to consume foods which raise HDL and decrease LDL in order to prevent various complications of Diabetes
Fats in our food
Fats are present in most of the foods we consume regularly, they are the most popular medium of cooking. Fats are available in different forms which vary in the quantity, texture and quality. Some are beneficial while others harmful for our general health and that of Diabetics in particular.
Transfats
Transfats re manmade fats- they are manufactured by passing hydrogen gas through vegetable oils, which gives them a grainy texture-like that of clarified butter. These are very harmful as they decrease HDL and raise LDL, which greatly increases the chances of heart attcks, stroke, kidney disease and other serious complications, and should be completly avoided. Unfortunately they are very popular in the coomercial food industry because they are cheap and foods prepared in them have longer shelf life. They are used in bakeries as vegetable shortening for making cakes, pastries, cookies etc. Examples: Vanaspati ghee, shortening for bakery, margarine.
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Saturated fats
These are mainly animal fats, like butter, cheese, cream, clarified butter, lard, meatalso in Coconut oil Hydrogenated vegetable oils- they raise LDL and total cholesterol if consumed in large quantities and should be consumed so much as recommended.
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Tips for Diabetics
All fats (oils) which become solid at room temperature are 30-38 deg are harmful for the body
Unsaturated fats
These are perhaps consumed in maximum quantities, as they make up most of the cooking oils like Sunflower, Safflower, Cornoil,
These can be further divided in two categories- Polyunsaturated and monounsaturated
Polyunsaturated fats
Polyunsaturated fats makeup most of the cooking oils like Sunflower, Safflower, Corn oil, Cotton seed oil, Peanut oil, Linseed oil, If consumed liberally they may increase Total Cholesterol and LDL and thus pose a risk to Heart and Blood vessels supplying both heart and brain and legs.
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Omega-3 fatty acids
There are two major subtypes of Polyunsaturated Fatty Acids (Omega-3) ?-3 and ?-6. ?-3 are beneficial for heart and blood vessels, they prevent are highly recommended for Diabetes and Heart patients
Sources of ?-3 PUFA: Wheat Bajra; Black gram, cowpea, Rajmah, Soya; Green leafy vegetables, Fenugreek & Mustard , Walnut, Flaxseeds; Mustard, soyabean & Canola oil. Fish is a very good source of ?-3 PUFA, specially oily fish like tuna, mackerel & salmon, single serving of fish 2-3 times a week is good for heart.
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Monounsaturated fats
These are the most beneficial oils of all- they increase HDL- the protective cholesterola nd decrease LDL and total cholesterol, They are present in maximum quantities in Olive oil, Canola oil, Peanut oil, Rapeseed oil, sesame oil.
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Tips for Diabetics
Fats and oils may decrease the Glycemic index of foods - bu they are harmful for the body. Fried foods always have lower glycemic index but they are more harmful.
Intake of Fats
Approx 25-30 % of all calories consumed daily should be from fats in which less than 10% should be from Polyunsaturated fats 10% or more from Monounsaturated Fats and less than 10% from saturated fats. Transfats ( Hydrogenated vegetable oil) should be avoided altogether as it is very harmful for the cardiovascular health and may lead to heart attacks and stroke.
Carbohydrates are the principal source of energy in our food. They also make up the bulk of the food. Carbohydrates are further broken down by the process of digestion to give Glucose- the main culprit for rise of Blood sugar after meals. Hence understanding carbohydrates is very important for all diabetics.
Energy
Each gram of carbohydrate provides approx 4 kcals of energy. In simple terms the energy released by one chapati would be more than enough to boil 12 a cup of water.
Fortunately not all carbohydrates are broken down and absorbed by the body after digestion- these are called dietary fibres, even though they are chemically classified as carbohydrates they do not atribute to any rise in blood glucose, but on the contrary cause delay in absorbtion of glucose, they are helpful to diabetics and must be included in their diet in plenty.
Not all Sugar is sweet- Not all sweet is sugar
Remember- not all glucose ( carbohydrates) are sweet, some forms of carbohydrates present in vegetables may not taste sweet at all, but still contain glucose in other complex forms, after being digested such foods would cause a rise in blood sugar- an example is fine wheat flour- it may not be sweet, but after consumption in cooked form- like bread or cake it may raise blood glucose in the same manner as sweet sugar or glucose powder.
On the other hand not all that is sweet may contain same amount of glucose, for example even very sweet fruits contain fructose- a type of sugar which is almost twice as sweet as glucose and even relatively small amounts in fruits would make them appear sweet. Furthermore body doesnot require insulin to utilize fructose hence even a diabetic person may eat sweet fruits without raising blood glucose( click here to read more on this).
Types of Carbohydrates
Carbohydrates present in diet may be divided into refined and coarse- from diabetes point of view. Refined carbohydrates are those which are quickly digested and glucose is immediately absorbed into circulation. Consumption of such foods give rise to peaks ( High) in blood glucose values after meals and are detrimental for Diabetics- leading to complications of Diabetes. Some examples of refined carbohydrates are, foods made of refined wheat flour- white bread, pastry, highly processed ready to eat cereals, Sugar and sweets, Starches and foods made from them- like corn syrup and corn flour. These are also called as foods with high glycemic index.
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Coarse carbohydrates are those types which contain undigestible dietary fibres together with digestible carbohydrates. The presence of fibres delays the digestion of food and subsequent rise in blood glucose levels, as a result the irise in blood glucose is stretched over time and blood glucose levels do not peak but remain in the normal range- even though the total carbohydrate content of the food may be same, these foods are the ones with low glycemic index. Examples of such foods are- Flour with bran, semi cooked cereals, green vegetables, fruits, chicken with flesh, brown bread, bread with whole grains. These are highly recommended to be included in each meal for Diabetics
Knowledge of Glycemic index is very helpful in deciding the beneficial foods for Diabetics, some foods with low glycemic index should also be avoided as they tend to raise cholesterol and triglycerides e.g butter, fried foods - this leads to Atherosclerosis & Cardivascular complications of Diabetes.
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Carbohydrate intake
A diabetic persons diet should contain approx 55-60% calories derived from Carbohydrates, In other words carbohydrates form the bulk of our diet. An average diet of a non obese 60 KG Diabetic person would be of (25 X 60=1500 Kcals), which means 900 Kcals should be derived from Carbohydrates, i.e approx 214 gms of carbohydrates can be consumed in a day.
Listed below are the Carbohydrate contents of some common staple foods:
Vitamin B12 has multiple effects in the body- mainly related to cell duplication and growth, formation of myelin sheath on nerve
fibres ( which help in transmission of nerve signals), regulation of homocysteine levels in blood.
Symptoms of Deficiency
Deficiency of Methylcobalamin or cyanocobalamin- source of Vitamin B12 may lead to peripheral neuropathy and anemia, low levels of
homocysteine- predisposing Diabetics to Stroke and Heart attacks, it may manifest as depression and fatigue as well.
Causes and Treatment of deficiency
Deficiency of this Vitamin may be caused due to some commonly used medicine for treatment of Diabetes-Metformin. Other important
causes could be reduced intake in food, liver disease, excessive alcohol intake, Gastritis or prolonged treatment with Antacids.
Dietary Source of Vit B12
Appropriate quantities of this should be taken with food. Food products rich in this vitamin are - Meat, specially goat liver,
eggs, milk and milk products, fish, molluscs. If required Tablets and injections of vit B12 can also be taken, but only under the
supervision of your doctor. Excessive intake of this vitamin is also not recommended as it can result in toxicity and cause
diseases of the nervous system.
IMPORTANT for Diabetics..
Vitamin B12 is present only in foods of animal origin like Milk & Dairy products, Liver, meat, fish and poultry. These foods may potentially be harmful for Diabetics if consumed in uncontrolled portions. Most of these products contain invisible fats which are high in Saturated fats. If you are a vegetarian prefer only toned or low fat milk and its products, if non vegetarian please adhere to the portions as advised by your doctor or dietician.
Importance in Diabetes
Vit B12 is used for the treatment of peripheral and other Diabetic Neuropathies. It may be taken as injections, Tablets or
capsules and mat be required over a long period of time.
Ascorbic acid - the source of Vit C was one of the first vitamins to be named as a 'vitamin'. Vit C has multiple important functions in our bodies, it helps in building of collagen- which acts as the matrix of the body, Vit C is also a very potent Antioxidant, it scavenges the free radicals which are responsible for many complications of diabetes like Atherosclerosis and predisposition to Heart Attacks and Stroke. Excessive free radicals may also result in diseases like cancer. Vit C has other important functions in metabolism as well.
Deficiency
Deficiency of Vit C leads to a disease called Scurvy, it used to be highly prevalent in seafarers going on long voyages, due to lack of fresh green vegetables and fruits. Even though it was noted even in 18th century that german sailors who used Sourcabbage did not suffer from this disease. Scurvy causes non healing wounds and ulcers, dark patches on skin, Bleeding from gums. Complete deficiency of Vitamin C may even be fatal. Modern researchers have also attributed Atherosclerosis- formation of plaques in blood vessels - leading to Heart Attack & Stroke in Diabetics.
Causes and Treatment of Deficiency
Deficiency of Vit C is caused by decreased intake of fresh green vegetables and fruits in diet. Vit C may also be destroyed when vegetables and fruits are cooked and processed.
Foods containing Vitamin C
Fruits
Citrus foods are traditionally well recognized sources of Vitamin C, like Lemon, Lime, Oranges, Mandarin oranges, Grapefruits and can be had by Diabetics.
Berries
Other fruits which also contain Vit C are- Guava, Papaya, Kiwi, Lychee, Wildberry, Elderberry, Strawberry, passionfruit, mango, melon. Berries are rich sources of vit c like raspberry, bluberry, blackberry, cranberry.
Vegetables
Vegetables like Broccoli, Cabbage ( Sour Cabbage ) , Brussel Sprouts, Cauliflower, Spinach, Parsley, Potato, tomato also contain Vit C
Special foods rich in Vitamin C
Some fruits and berries contain high amounts of this Vitamin 10-1000 times that of usual fruits and vegetables- and need special mention- Kakadu plum, camu camu, Rose hip, Acerola, jujube, Indian gooseberry ( Amla), Seabuckthorn, Blackcurrant.
Animal sources of Vitamin C
Present in Liver and uncooked meat and fish preserves. Present in milk and milk products.
Significance in Diabetes
Sufficient amounts of Vitamin C should be taken by Diabetics in order to prevent the longterm complications of Diabetes. Vitamin C is a potent antioxidant and promotes healing of wounds. Oxidative stress is increased in diabetes and may be the cause of damage to pancreas and blood vessel walls which lead to worsening diabetes and its complications, deficiency of Vit C would only accentuate these. When Vit C is consumed in form of fresh fruits and vegetables it also increases fibre intake which helps in lowering blood glucose levels.
It has been shown in studies that adequate intake of vit C in tomato juice in creases the blood lycopenes levels, decreases C-RP these may be helpful in preventing heart attacks, angina and stroke. Another study has shown link between decreased levels of vitamin C , Diabetic Nephropathy and high blood pressure.
Niacin aind Nicotinamide - both have the same activity as that of vit B3, These help in lowering total cholesterol and the harmful low densitycholesterol, Niacin has many other vital effects inthe metabolism other than lowering lipids, many of the by products formed during conversion of niacin to nicotinamide ( which is the active form of hormone) are essential in basic chemical reactions which deliver energy to the living cells. Niacin has an important function of increasing HDL (the protective) Cholesterol.
Symptoms of Deficiency
Gross deficiency of vit B3 causes Pellagra, this used to be endemic in some parts of Europe and America since the 18th century, when corn used to be the staple diet. In modern times this disease is seen only in malnourished individuals.
Causes and Treatment of Deficiency
The main cause of deficiency is poor intake with food. South Americans soak Corn in Lime to make it soft- this process is called Nixtilization and make the Nicotinamide present in corn available for absorption through our Gastrointestinal tract. Following foods may be rich sources of Niacin and can be used to treat deficiency of vit B3. Usualy Vit B3 is given throuh tabs as a component of multivitamin tabs or supplements. These should be consumed only under the supervision of a doctor as overdose may be very harmful and produce a number of adverse effects, including liver damage, diarrhea, itching and burning of skin etc...
Niacin can be used to increase HDL cholesterol- one of the major side effects of this medicine is flushing of the skin, even though it may be transient and dissapear over time. Some new medicines have been discovered recently which prevent the flushing reaction, and together with the extended release formulations of Niamicin are well tolerated by patients. In higher quantities Niacin may also increase blood glucose levels hence diabetics using Niacin should monitor their blood sugar levels regularly.
Vitamin D has important role to play in life of diabetics. It is derived from food and also made by the body in presence of sunlight.
Effects
Vitamin D or Ergocalciferol, or cholecarciferol has many important effects in our body. It helps in absorption of Cacium and phosphorus from the foods that we consume and their deposition in bones to make them strong. Vitamin D has many other roles as well- it helps build immunity and fight against infections, Vitamin D may also be helpful in treatment of depression. Some studies have shown that deficiency of vitamin D may cause and increase in insulin resistance and lead to overt Diabetes.
Deficiency of Vitamin D and symptoms
Deficiency of Vitamin D causes demineralization of bones making them soft and highly prone to fractures - this condition is called osteoporosis, adequate bone growth may not take place in children with deficiency of Vitamin D. Deficiency of Vitamin D is also associated with diseases like High Blood Pressure, Atherosclerosis ( clogging of blood vessels), Heart attcks, Inflammatory diseases like Rheumatoid Arthritis, psoriasis and associated arthritis. Vitamin D is also used in treatment of some cancers like breast cancer, as it kills some cancerous cells .
Dietary sources of Vitamin D
Interesting to note that Vitamin D can be made only in presence of sunlight, either in human beings lower animals or plants. Good source of Vitamin D is Fish oil and Cod Liver oil - even fishes contain vit-D which has been made by algae that they eat only in presence of sunlight. Molluscs, ( highest Vit-D content), Beef Liver, Fatty fishes- Herring, mackerel, Eel,Salmon, Sardine, Tuna, Catfish,, Eggs, chicken and poultry; Milk and milk products like yoghurt, cheese also contain Vitamin albeit in smaller quantities.
Presence of Vitamin D receptor in cells of pancreas and the and the fact that decreased Vitamin D also decreases insulin secretion ( even though in animal study) has again highlighted the importance of Vitamin D in Diabetes. Adequate intake of Vitamin D may be protective against development of Diabetes, as has been shown in a study conducted by Anastassios et al. New England centre of Medicine. Type 2 Diabetes generaly affects the elderly - this also is the agegroup of population suffering from Osteoporosis, hence it may be prudent for every Diabetic to take adequate supplementation of Vitamin D with food or as advised by doctor to avoid fractures associated with weak bones.
Vitamin E is one the most potent antioxidant substances, it has the potential to protect body from the destructive capability of Free radicals and these are molecules with available electrons for reaction with cells, tissues and their components. Oxidative stress caused by them is one of the important chain of events which lead to the atherosclerosis and subsequent damaging consequences responsible for Angina, stroke, Heart attack, Peripheral arterial disease and many other problems present in Diabetics. Free radicals may also be responsible for diseases like cancer. Besides being an antioxidant there are many oother fuctions attributed to vit D involved in cell signalling, regulation of gene expression and metabolic processes.
Deficiency of Vitamin D
Deficiency of Vitamin D by itself is very rare, may cause nerve damage, Deficiency may be a result of diseases of other organs of the body like intestines and liver. Chronic diseases which affect the absorption of food like Colitis, cystic fibrosis or Celiac disease may affect the absorption of Vit E and other fat soluble Vitamins.
Sources of Vitamin E
Wheatgerm is one of the richest natural sources sources of vit E.
Vegetables & Fruits
Green vegetables like Asparagus, Spinach, other green leafy vegetables, wholegrain foods, Avocado pears,
Oils and oil seeds
Red Palm oil, Corn oil, Safflower oil, Sunflower oil, Canola oil, cottonseed oil, olive oil, Nuts and seeds
Milk and Milk products
Significance in Diabetes
It has been shown that the damage to pancreas itself - which results in the loss of capability to secrete insulin is caused by free radicals at some stage. A number of complications of Diabetes are also attributed to free radicals and oxidative stress. Vitamin E being a potent antioxidant may play a vital role in preventing or delaying these complications, Even though none of the studies conducted till yet have shown and advantage of regular consumption of vitamin E supplements in high doses. But it is prudent to include foods which contain Vitamin D but in appropriate quantities.
It has been shown in some studies that vitamin E supplementation may blunt the increase in HDL caused by Niacin.
Understanding Food
