Diabetes has become a common word as we find many people dealing with this disease who have to face challenges every day due to their diet restrictions, maintaining the blood sugar levels, selectively looking for foods that have lower glycemic index and foods with low sugar. But do we realise it is not just a disease but a threat that’s not recent but is existing since ages. Diabetics’ number in India is rising rapidly and in 2030 it is expected to be 80 million making India the diabetes capital with maximum cases in world.
Obesity is one of the major risk factors for diabetes. In spite of lower overweight, obesity rates and BMI, India has higher prevalence of diabetes compared to western countries suggesting predisposition to diabetes. This makes Indians prone to development of complications of diabetes at earlier age of 20 to 40 years and also warns us that careful screening and monitoring is necessary irrespective of age. As it is reaching epidemic proportions with morbidity and mortality and potential complications being enormous, posing great burden on families and society, monitoring and intervention to mitigate the potentially disastrous increase are essential in near future.
Problems due to Diabetes
Diabetes has several causes some genetic and others being due to changes in physique and diet. The treatment and management of the disease may also be different for different types of diabetes. However, they all will need similar care as far as diet is concerned.
Because of lack or absence of insulin or due to resistance to insulin, when a diabetic consumes foods containing easily digestible carbohydrates they will produce glucose which will enter blood stream and the rate at which it enters will cause the rise in blood glucose. When this rise is very high the diabetics have different levels of discomfort or suffering which over a period can lead to serious complications.
Thus diet management is essential. From among the diet components it is the carbohydrate that needs to be managed. So when one plans the diet this is the foremost of considerations.
What are the Requirements of Diabetics
Earlier this was highly restricted with low carb diet. However it was realised that since body needed glucose for maintenance and health of an individual it cannot be cut drastically. So the next thing done was to ensure that the carbohydrates included should be such that they are not easily digested and if some are, then they are not easily absorbed. This strategy has been adopted more recently, which also gave rise to the concepts of glycemic index (GI) and glycemic load (GL).
One can design a meal with animal products, cereals and pulses, fruits and vegetables etc. choosing the low GI components that would ensure that after meal it would not give sudden rise in blood glucose. After eating a reference amount of carbohydrate containing food the extent of rise in glucose in blood determines it’s GI. Therefore, diet is chosen so there aren’t high GI foods such as white bread, boiled potatoes, sugar confectionery, white rice, sugar-sweetened beverages etc. but would contain low GI foods including whole grain products, lentils, nuts, apples etc. Some foods like brown rice are now again finding better market.Brown rice is whole-grain rice. Whole rice paddy when dehulled to remove inedible outer hull, we get brown rice containing bran layer so it looks brown. This is polished to remove bran to get white rice. Bran not only contain vitamins and minerals it also contains dietary fibre which makes it low GI food.
However, diabetics soon get tired of such foods and they are used to savoury or sweet foods with plenty of easily digestible carbs with high GI number. Snacks and beverages and sweets have become part of us not just because of the enjoyment but at times it is very difficult to get a square or regular meal and people have to sustain on these things which are easily available now in most workplaces. However, there is a need to make such products available that are diabetic friendly.
Making food products suitable for diabetics
Indians love their sweets and sugar in most sweets is very high. This makes these sweets unacceptable for diabetics. Some of the earliest attempts were to make low sugar or sugar less sweets using some alternative substances to sweeten the products. There are many products in the market that are sugar-free and have used sweeteners from FOS (fructose-oligo-saccharide), aspartame, K-acesupfame, stevia, sucralose and polyols.The two FOS and polyols have about the similar sweetness as sugar but others are high intensity sweeteners so their amounts necessary to provide sweetness are very little. This creates a situation due to removal of sugar from the sweet making. Removal of sugar from the sweet making creates a gap that needs to be filled by a bulking agent which will not only fill the gap created by lack of sugar but also provide the functionality such as texture, water retention, as well as flavour formation due to browning reaction among other things.
Function of Dietary Fibre
Dietary fibre has been one of the key components in the foods that are recommended for diabetics. There are two reasons for this. One is that they make the digestion of carbs more difficult delaying the release of glucose. Secondly they also increase viscosity in fluids so transfer of glucose after release to the site where it is absorbed into blood is also slowed and so delayed. Thus rise of glucose in blood is slow and not sharp. That is the reason for foods such as whole grain, pulses and fruits with high dietary fibre to have low GI. The fibre delays digestion as well as transfer of glucose into blood thereby lowering GI value.
Use of Millets and Soya
There are many products which are entering market made with soya flour or millets, both having good amount of dietary fibre and have low GI. Some of these flours have been used to make many products such as cookies and instant mixes for dosa etc. Many snack items can also be prepared.
Many flours have appeared either mixed with wheat flour or without it. Ragi, bajra, soya, pulse and/or other flours are used to lower the GI of wheat flour. Wheat flour have very high GI of 70 or 80 but when other flours are added, the GI lowers to medium or even fall in low GI range below 55. The developer must ensure that the taste and characteristics of bread, chapatti or roti is not affected adversely due to addition of other flours. Consumers will certainly try healthier product but will not sacrifice quality or taste of the final product.
Ms. Swechha Soni
Manager – Food & Nutrition
Dr. Jagadish Pai