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CARBOHYDRATES – FRIEND or FOE?

One of the most common answers I get when I ask my patients about their first thoughts when diagnosed with diabetes is, ‘Oh! I have never eaten much of sugar, rice, sweets or potatoes etc; yet I have this disease. Now I can’t eat any food that I love.’ In other words, as soon as one is diagnosed with this lifelong disease, the feeling of deprivation is introduced in them. Society in general, further adds to this feeling of dejection and confusion. Unscientific remedies are then tried, which worsen the glycemic control (controlling the level of sugar or glucose in blood) leading to further medicinal and other forms of intervention in the future.

People with diabetes often make wrong assumptions about the reasons for diabetes occurrence and its management. This stems from denial about being a diabetic, about having to make changes to control it and about needing the support of family and friends to combat this life altering and if not managed properly, life threatening disease.

The most important dietary rule of Diabetes: There is NO “Diabetic Diet”.

This is extremely important to understand, assimilate and keep in one’s mind through all the ‘tried and tested’ diet recommendations of ‘knowledgeable’ friends, neighbours and your gym instructor. Healthy eating isn’t about deprivation or denial. Having diabetes need simply translate into eating a variety of foods in moderate amounts and sticking to regular mealtimes. This means choosing a diet that is balanced in all macro-nutrients like carbohydrate, protein, healthy fats and all essential vitamins and minerals.  There is NO “diabetic diet” as such. It’s a diet that is nutritionally adequate, tasty and individualised, a diet that even non-diabetics should follow to stay healthy and prevent diabetes and other lifestyle diseases.

Macronutrients are essential for proper body functioning. It is important for a Diabetic patient to know which food will raise their blood sugar to what extent. Out of the three major nutrients, carbohydrates contribute the most to blood sugar levels.

Carbohydrates (‘carbs’) are the sugars, starches and fibres found in fruits, grains, vegetables and milk products.  There are two types of carbs: simple and complex.  Whole grains like wheat, oats, barley, pearl millet, whole fruits and vegetables, brown and red rice are all good sources of complex carbs. All these food items when processed into finer grain size and products become simple to digest and also increase blood sugar very fast. Soda, bread, cookies, candy, juices, cola, sugar, honey, jaggery are some sources of simple carbs.

Bottom line: complex carbs occur in nature in grains, vegetables, pulses and fruits. Simple carbs are created in factories and processing centres by breaking down these healthy carbs into easily digestible and high sugar yielding form. When going with carbs, the simple choice is complex.

Monitoring carbs is the key strategy in achieving glycemic control. Both the amount (grams) of carbohydrate as well as the type of carbohydrate (simple or complex) in a food influence blood glucose level. While emphasis should be on complex (high fiber) carbohydrates, excess amount of even complex carbs in a meal could be detrimental and lead to hyperglycemia (high blood sugar).

Amount of carbohydrates that a diabetic can consume per meal is dependent on many individual factors. The optimum amount of carbohydrate depends on many things including how active a person is and the medication he is taking.  Few classes of anti-hyperglycaemic medication may alter the absorption of carbohydrates, and so the patients should be well educated on the importance of carbs in their meal. Carbohydrate intake and distribution per meal should be constant every day, so avoid ‘binge’ meals after a successful period of dietary control to celebrate.

The recommended range of carbohydrate intake is 45–65% of total calories. Brain and heart have an absolute requirement for glucose as an energy source. So, restricting total carbohydrate to <130 g/day (approximately 6 cereal exchanges/ day) could impair the functioning of these vital organs and could also lead to hypoglycemia (low blood sugar). While the patient might want to follow a certain low carb diet, families find it difficult to follow a restrictive carbohydrate plan and studies have also shown that rigid approaches to diabetes management may contribute to disordered eating behavior.

(Cereal Exchange: an exchange can be understood as, 1 medium sized bowl of brown rice, 1 fistful of pasta, 1 palm sized chapatti, 2 medium sized idlis, 1 medium bowl of broken wheat or oats porridge, 1 slice (3 X 3 inch) of whole wheat bread.)

Carbs are a must in every major meal especially following alcohol consumption. The liver is responsible for releasing stored glucose in between meals to regulate sugar levels, which it cannot do until the alcohol is substantially metabolized. Therefore, a source of carbs is required in the next meal to regulate sugar levels and avoid hypoglycemia.

Finding the balance for an individual is important so they can feel their best, do the things they enjoy, and lower their risk of diabetes related complications. Once a diabetic individual has improved knowledge on how much and what type of carb to eat in meal and how their bodies respond to these carbs, they should be allowed to choose types of food and portion sizes. Everyone likes to have multiple choices to choose from instead of a rule book to be followed. Healthcare professionals, diabetes educators, dieticians can offer a variety of methods that can be used to estimate the carbohydrate content of meals.

Non-compliance to diet recommendation is often a result of the individual’s barriers like difficulty in understanding what constitutes a portion size, knowledge about how to balance the diet and reading food-packaging labels. Dietary change is not easy because it requires alterations in habits that have been built up over a long period of time. Maintaining this behaviour change is even more difficult and requires motivation, behavioural skills and social support. One size-fits all, traditional dietary advice like handing all patients pre-printed “diet sheets” are not resulting in desired behaviour modification. Every individual is different and hence there is a need for a more customised approach in diet planning and counselling.

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