2-3In TouchDIeTary recommenDaTIons In DIabeTes

W e have been publishing articles on some of the lifestyle disorders that affect population in general and Indians in particular. We have shared with our readers articles on obesity,

diabetes, and hypertension, and their management. But the prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Over the past thirty years, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity

Editorial BoardDr. P. H. AnAntHAnArAyAnAnHead, Department of Biochemistry, JIPMEr, Puducherry

Dr. BHAskAr rAJuHOD, Paediatric Gastroenterology Institute of Child Health, Chennai

Dr. uMEsH kAPIlProf. Dept. of nutrition, AIIMs, new Delhi

Dr. kAMAlA krIsHnAsWAMyretd. Dir. & Emeritus Medical scientist (ICMr) nIn., Hyderabad

rEsEarch suB-committEEDr. n. k. GAnGulyretd. Director General, ICMr, new Delhi

Dr. rAkEsH tAnDOnretd. Prof. & Head Dept. of Gastroenterology AIIMs, new Delhi

Dr. AnAnD PAnDItHon. Prof. & Director, Dept. of Paediatrics, kEM Hospital, Pune

Dr. J. s. PAIExecutive Director, PFnDAI, Mumbai

S C I E N T I F I C C O U N C I L M E M B E R S ( S C M )othEr scmsMr. V. MOHAnVice President/Director Hr & legal Heinz India Private limited.

Dr. GODADHAr sArAnGIDirector, the Child, Cuttack.

Dr. B. n. MAtHurretd. Director, nDrI, karnal

Dr. sArAtH GOPAlAnExecutive Director, Crnss, new Delhi

Mr. P. P. rOyAssociate Vice President, r&D, Heinz India Private limited

Ex-officio mEmBErDr. IDAMArIE lAquAtrADirector, Global nutrition, World Headquarters, H J Heinz Company, Pittsburg, usA

trustEEsMr. n. tHIruAMBAlAMChairman & Managing Director, Heinz India Pvt. ltd.

Dr. y. k. AMDEkArretd. Hon. Prof. of Paediatrics, Institute of Child Health, Mumbai

Mr. nIlEsH PAtElPresident, P.t. Heinz ABC, Indonesia

managing EditorP. JAGAnnIVAsDirector, Heinz nutrition Foundation India, Mumbai

and mortality affecting the youth and middle-aged people. Various epidemiological studies show that the number of people with diabetes is increasing due to population growth, aging, urbanisation, and increasing prevalence of obesity and physical inactivity. the major driver of the epidemic is the more common form of diabetes, namely type 2 diabetes, which accounts for more than 90 per cent of all diabetes cases; though increase is also seen in the prevalence of type 1 diabetes.

Dr. V. Mohan, Madras Diabetes research Foundation & Diabetes specialties along with his team has written an article with the title Current Perspectives on Dietary Recommendations for the Management of Type-2 Diabetes in India. there is also an interesting section which answers a few commonly asked questions about diabetes. While concluding on the dietary management of diabetes he writes, “Meal plan should always be used in conjunction with other lifestyle modifications and for example, increasing physical activity and stress management to produce optimal results.” the message is clear that each one of us has to watch our diet and set aside some time for physical activity.

N. ThIRUaMBaLaMCHAIrMAn & MAnAGInG DIrECtOr,HEInz InDIA PVt. ltD.

contentsMESSaGESmd’s message Page 1dr. amdekar’s message Page 8

LEaD aRTICLEcurrEnt PErsPEctiVEs on diEtarY rEcommEndations for thE managEmEnt of tYPE-2 diaBEtEs in indiamohan V, shobana s, mookambika ramya Bai r and sudha V Page 2-5

frEquEntlY askEd quEstions aBout diEt and diaBEtEs sudha V, thangamani and mohan V* Page 6-7

hEINZ NUTRITION FOUNDaTION INDIa

VolumE 13 z numBEr 2 z JulY-sEPtEmBEr 2011 z For Private CirCulation only

In TouchJuly-september 2011

MOhaN V, ShOBaNa S, MOOkaMBIka RaMya BaI R aND SUDha V

corrEsPonding authorDR V. MOhaNmadras diaBEtEs rEsEarch foundation & dr. mohan’s diaBEtEs sPEcialtiEs cEntrEWho collaBorating cEntrE for non-communicaBlE disEasEsintErnational diaBEtEs fEdEration (idf) cEntrE of EducationgoPalaPuram, chEnnai, india.Email: drmohans@diaBEtEs.ind.in

Diabetes is a metabolic disorder characterised by chronic hyperglycemia (high blood glucose levels) with altered metabolism of carbohydrates, fats, proteins, resulting in insulin deficiency and inefficiency or both. Today, more than 50.8 million people are affected with diabetes

in India and this figure is expected to rise to 87 million by the year

2030. type 2 diabetes accounts for over 90 per cent of diabetes cases, and the increase in numbers appears to be mainly related to the increased prevalence of obesity and predominant sedentary lifestyle with energy dense food intake. Appropriate food choices in our daily diet could potentially mitigate the burden of diabetes and its complications and improve glycemic control. this article focuses on the current dietary recommendations for type 2 diabetes.

hISTORICaL pERSpECTIVE OF DIETaRy MaNaGEMENTDiet therapy for diabetes has long been practiced by Egyptians even in 3500 BC. In India, 2,500 years ago, sushrutha and Charaka emphasised on the diet restrictions for the treatment of diabetes. Before the discovery of insulin in 1921, the primary treatment was an extremely low calorie and low carbohydrate diet (starvation diets). After the discovery of insulin, carbohydrate intake was liberalized though restriction of carbohydrates (20-45 per cent calories as carbohydrates) continued in the West. As early as 1958, late Prof. Viswanathan conceived the concept of high-carbohydrate and high fibre (HCHF) diet in South India and found it to be effective in controlling blood glucose, and lipids and improve peripheral insulin sensitivity. the last few decades witnessed a major shift

cUrrenT PersPecTIVes on DIeTary recommenDaTIons For THe manaGemenT oF TyPe-2 DIabeTes In InDIa

2-3in the quality of cereal grains such as rice, due to the advances in milling technology to improve the rice yield and shelf life. the result is that today we have polished white rice with higher glycemic impact compared to the whole grains used in the past.

kEy pRINCIpLES OF DIETaRy MaNaGEMENTDiet therapy remains the sheet anchor in the clinical management of diabetes. People with diabetes need not follow a so called special diet (diabetic diet) or adhere to a list of restricted food choices as was done earlier. In the current scenario of the obesity epidemic (across all age groups) and higher prevalence of chronic diseases (diabetes, heart diseases and cancer), the optimum healthy choice of foods in the diet for people with diabetes is the same as for the general population with some modifications. We do not recommend cooking separately for a person with diabetes in a family as it could affect long term compliance.

Lifestyle modifications should include, in addition to healthy eating, increasing physical activity and stress management. Isolating a person with diabetes and stigmatizing him or her can be counter productive for the management of the disorder. similarly, special diabetic products are rarely necessary and do not necessarily contribute a healthy diet. Indeed they have already disappeared in the supermarkets abroad. Healthy food choices are needed for everyone to lead a healthy lifestyle, whether one has diabetes or not. Instead diabetes should be taken as an additional motivation for adopting a healthy lifestyle.

Dietary advice needs to be holistic and one should encourage people with diabetes to manage their diabetes and make conscious decisions. the diet recommended needs to be complementary to other treatments such as pharmacological, physical activity and behavioural (example- smoking cessation) therapies. Dietary advice must also take into consideration the individual’s preferences, cultural background and lifestyle.

GOaLS aND pRINCIpLES OF DIETaRy MaNaGEMENT OF DIaBETESz the primary aim of dietary intervention is basically the same for

most forms of diabetes. A diet plan should assist in improving and maintaining normal/optimal metabolic profile and include optimal glucose control, improved lipid profile and controlled blood pressure is essential.

z Emphasis for persons with type 2 diabetes needs to shift from weight reduction to better metabolic outcomes as both weight reduction and energy restriction (independent of weight loss) and/or increased physical activity improves insulin resistance and thus glycemic control.

z Consistency of carbohydrate intake at meals and snacks is important for greater impact on lowering postprandial glucose levels especially for those on medication for diabetes.

z One should aim for lower fat intake to improve lipid profiles and thus the cardio metabolic outcomes.

z Meals should be spaced by distributing food intake throughout the day based on individual preferences.

z Individualized dietary counseling improves compliance compared to printed diet sheets.

z Dietary education needs to be an ongoing interactive process of follow up, support and not a single session.

z reinforcement is the key to success.

NUTRITIONaL RECOMMENDaTIONS FOR TypE 2 DIaBETESCaRBOhyDRaTE : z total carbohydrate: 55-60 per

cent of daily energy requirements, use one low glycemic index food in each meal to reduce the overall meal glycemic load.

DIETaRy FIBRE Adults: at least 25-40 g/day.

pROTEIN Adults: at least 1.0 g/kg/day.

FaTS z total fat: 20-25 per cent of

daily energy requirements. z Essential PuFAs (lA) should

provide 5- 8 per cent of total energy/day.

z AlA should be 1-2 per cent of total energy/day .

z Saturated fats: < 7 per cent of daily energy requirements.

z trans fat : <1 per cent of daily energy requirements.

z use of monounsaturated fats should provide 10-15 per cent of total energy/day.

z Cholesterol intake 200 - 300 mg/dayz Fish or foods rich in omega-3 fatty acids (walnuts,

flaxseeds and canola oil) should be consumed whenever possible.

aLCOhOL Alcohol consumption should be in moderation. Excess alcohol intake can contribute to weight gain, poor glycemic control (due to empty calories), and elevated lipids apart from risk of pancreatitis.SwEETENERS z nutritive and non-nutritive sweeteners may be

used moderately as part of a well- balanced diet. Free sugars are better avoided and if included should be < 10 per cent of total calories/day and this includes sugar added and present in honey, syrups and fruit juices.

z use of saccharin and cyclamate is not recommended during pregnancy and lactation.

z Aspartame is contraindicated in individuals with phenylketonuria or in children below 12 years of age.

MICRONUTRIENTS routine use of vitamin or mineral supplements is not recommended for people with diabetes except in cases of nutritional deficiencies.

Basal metabolic rate (BMr) and activity factor together contribute to the energy requirement for an adult individual. BMr accounts for 70 per cent of the total caloric requirement to maintain various bodily processes and body temperature. though various factors are involved in estimating BMr the quick clinical method is as followsBMR – Men = 24kcal/kg body weight/dayBMR- Women = 22 kcal/kg body weight/day

Activity factor is based on the physical activity level and categorized as sedentary (25-30 per cent BMr), moderate (35-50 per cent BMr) and heavy/strenuous (50-100 per cent BMr).Example total energy requirement for an adult sedentary female with 55kg body weight:BMR = 22 kcal x 55kg = 1,210 kcalsActivity factor = 25 per cent BMR calories = 303 kcalsTotal energy requirement = BMR + Activity factor = 1,210 + 303= 1,513 kcals

Alternatively, energy requirement can also be determined based on the ideal, under and overweight categories as provided in the table. Ideal body weight is a body mass index (BMI) between 18 and 22.9 kg/m2.

such as refined cereals, example white rice tend to raise blood glucose levels quicker than the whole grains like brown rice or whole wheat. the glycemic property of the food is assessed in terms of glycemic index (GI). It is a scale that ranks carbohydrate-rich foods by their ability to raise blood glucose levels when ingested compared to a standard food (glucose or white bread). Based on GI, foods are classified as low GI (< 55), intermediate GI (56 - 69) and high GI (> 70). High GI foods cause the body to produce larger amount of insulin and higher levels of insulin in the blood. low GI foods lower the levels of blood glucose and insulin and could potentially reduce large blood vessel damage, a common diabetic complication.

BENEFITS OF LOw GI DIETz useful in the lipid management- decrease triglycerides and lDl-

cholesterol and increases HDl cholesterol. z Insulin resistance can be favourably modified.z Postprandial glycemia and thus reduce the risk of cardiovascular

disease.z Enhanced weight control since the diet promotes satiety,

minimizes postprandial insulin secretion and improves insulin sensitivity.

ExaMpLES OF DIFFERENT GI FOODS loWEr gi z Whole grain products, legumes, pasta, milk and yoghurt.mEdium gi z low fat whole grain products (oats and ragi cookies), fruits.high giz White rice, white flour, corn based breakfast cereals, boiled and

mashed potatoes, fruit juices, porridge made from refined grains.

FIBRERecommended fibre intake is 25-40 g/day or 15-25 g/1000 kcal. Dietary fibre, both soluble and insoluble have a favourable effect on all aspects of glucose and lipid metabolism. In addition, fibre forms

the bulk, has greater satiety value, can prevent constipation and reduce the risk of colon cancer.

FaTScientific evidence suggests that high intake of both polyunsaturated fatty acids (PuFA’s)- linoleic acid (lA) and alpha linolenic acid (AlA), balanced lA/AlA ratio (5-10) and long chain n-3 PuFA’s from fish/fish oils could reduce inflammation, micro and macro vascular complications of diabetes. Fat recommendations are shown in table 1. to ensure optimum fat quality in Asian Indian diets use of two or more vegetable oils is recommended (oils in 1: 1 proportion), examples: groundnut/gingelly/rice bran + mustard/soybean; palmolein + soy bean; sun flower + groundnut/gingelly/rice bran.

the recommended dietary guidelines for fat based food choices include moderation in the use of animal foods containing

TaBLE 1. CaLCULaTION OF ENERGy REqUIREMENT.Overweight and obese (BMI >22.9 kg/m2) 20 kcal/kgIdeal weight (BMI 18-22.9 kg/m2) 30 kcal/kgunder weight (BMI <18 kg/m2) 40 kcal/kgPregnancy 30-35 kcal/kgChildrenBasal 1,000 kcalBoys upto 12 years 1,000+125 kcal for each year of ageGirls upto 12 years 1,000+100 kcal for each year of age

sourcE: raghuram Et al. diEt and diaBEtEs. national institutE of nutrition, hYdEraBad, 1993.

CaRBOhyDRaTESBoth the quality and quantity of carbohydrates are equally important. Our recent study on the dietary profile of urban adult population showed that in urban south India refined cereals especially highly polished white rice was the major source of carbohydrates and that this was directly associated with the risk of type 2 diabetes. the consumption of whole grains (such as millets) has gone down in India. Higher intake of refined cereals which are low in dietary fibre may produce with unfavorable metabolic profile that is, worsen blood glucose control, increase serum triglycerides and lower HDl cholesterol levels and this predispose to cardiovascular disease.

Foods containing carbohydrates are today better classified based on their blood sugar raising potential as glycemic carbohydrates and non-glycemic carbohydrates. Glycemic carbohydrates

In TouchJuly-september 2011

4-5high levels of fat, saturated fats, and cholesterol, minimize consumption of pre-mixed, ready to eat, fast foods, bakery foods and processed foods prepared in partial hydrogenation of vegetable oils like pastries, which are high in trans fatty acids.

pROTEINS Protein intake should be approximately 10-15 per cent of the total caloric intake. this can be obtained either from vegetarian or non-vegetarian sources. For the individuals with diabetic nephropathy, 0.8 g/kg body weight/day is recommended, whereas for those without nephropathy 1.0g/kg body weight/day is recommended. Protein requirement increases during illness, infection and surgery. Proteins from vegetable sources include pulses and legumes, low fat milk and milk products, fish and lean meat. The biological value of protein should also be considered.

SwEETENERSEach sweetener has its distinctive tastes and advantages. saccharin, aspartame and acesulfame- k and sucralose are all approved by the us FDA and American dietetic association for use by people with diet. these are non-nutritive sweeteners. nutritive sweeteners such as fructose or sugar alcohols are included in the carbohydrate total for meals and/or snacks. Consuming amounts greater than 10g per day of some sugar alcohols such as sorbitol may cause diarrohea.

SaLT salt intake should be less than 5g of sodium chloride (2 g of

4-5

REFERENCES1. unwin n, Whiting d, gan d, Jacqmain o, ghyoot g (eds). international diabetes federation diabetes atlas. fourth Edition. international diabetes federation, Belgium, 2009.2. Viswanathan m, mohan V, dietary management of indian vegetarian diabetics: nfi Bulletin. 1991; 12: 1- 3.3. Parivallal, t diabetes in ancient india. in: type 2 diabetes in south asians: Epidemiology, risk factors and Prevention. sasat, 2007; 1-19.4. mahendri, sarah J, mary m, nihal t, kanakamani J, Jachin V, senthil V. a practical guide to diabetes mellitus 5th edition; academa Publishers delhi. 2010, chapter-3. 5. raghuram, t.c, sharma, r.o. diet and diabetes. national institute of nutrition, hyderabad, 1993; 63.6. Radhika G, Van Dam RM, Sudha V, Ganesan A, Mohan V. Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology study 57). metabolism. 2009; 58(5), 675-81. 7. Radhika G, Sathya M, Ganesan A, Saroja R, Vijayalakshmi P Sudha V and Mohan V. Dietary profile of urban adult population in South India in the context of chronic disease epidemiology (curEs – 68). Public health and nutrition. 2010; 12: 1-8.8. Mohan V, Saroja R and Sudha V. Experience with dietary management in diabetes mellitus in South Indians. Nutrition Goals for Asia Vision-2020; Proceedings IX Asian congress of nutrition. nutrition foundation of india; 1st Ed. 2003; 528-32.9. Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values. Diabetes Care. 2008; 31 (12), 2281-2283.10. miller JB, Wolever tms, Powell kf, colagiuri s. the new glucose revolution. marlowe & company new York; 3rd Ed. 2007. 11. Gandy JW, Madden A and Holdsworth M. Oxford Handbook of Nutrition and Dietetics. Oxford University Press; 1st Indian Ed. 2007; 423-48.12. Orland MJ, Diabetes Mellitus and Related Disorders. The Washington Manual of Medical Therapeutics; Lippincott-Raven Publishers, New York. 1998; 396-417.13. misra a, sharma r, gulati s et al., consensus dietary guidelines for healthy living and Prevention of obesity, the metabolic syndrome, diabetes, and related disorders in Asian Indians. Diabetes Technology & Therapeutics. 2011, 6 (13); 683-94.14. American Diabetes Association: Standards of Medical Care in Diabetes 2011. (Position Statement). Diabetes Care. 2011; 34 (Suppl): S22.

sodium) per day. Preserved foods containing appreciable amounts of salt such as pickles, pappads, chutneys, namkeens, bakery items, chips, dried cured meat products, canned foods, cheese, soups should be limited as high sodium can increase the risk of blood pressure. Our recent study had also shown that higher intake of added salt in the diet increased the risk for hypertension among urban south Indians.

DIaBETIC FOODSDiabetic speciality foods are generally not recommended for people with diabetes as they are not necessarily healthy. For example, the so called diabetic sweets may not contain sugar but do contain high amount of fat. the word ‘diabetic’ attached to a food may be interpreted by persons with diabetes as a special food for them with therapeutic benefit ending up in consuming large portions which could be detrimental to health.

CONCLUSIONDiet for person with diabetes is no different from the healthy diet for general population. However, individualized dietary management is important for the successful management of diabetes. the macronutrient distributions in terms of total calories are carbohydrates (55-60 per cent), fat (20-25 per cent) and

protein (10-15 per cent). Both quality and quantity of carbohydrates deserve the same attention just as quality and quantity of dietary fats. Meal plan should always be used in conjunction with other lifestyle modifications, for example increasing physical activity, and stress management to produce optimal result.

Frequently asked questions about diet and diabetes sudha V, thangamani and Mohan V*

1 DOES ONE wITh DIaBETES NEED TO EaT a SpECIaL DIET wITh LOT OF RESTRICTIONS?

no. the diet for diabetes is a balanced healthy diet, the same kind that is recommended for the rest of the population - low in fat, sugar and salt, with plenty of vegetables and whole grains. living with diabetes doesn’t have to mean feeling deprived or restricted food intake. the secret of a healthy diet is variety (foods from various food groups) and moderation (right serving size to suit the physical activity and body weight) to attain a healthy balanced diet.

2 whICh CEREaL STapLE IS ThE BEST FOR DIaBETES?

IS IT RICE OR whEaT?Indians culturally eat cereal based high carbohydrate diets. Cereal grains are available as whole grains or refined grains. The cereal that contains all of its bran, germ and starchy endosperm is called the whole grain (examples: whole wheat, brown rice) and the grains that are devoid of bran and germ and contain only the starchy endosperm are called refined grains (white rice/polished rice, maida based products like white bread). Refined grain such as white rice gets digested faster and hence raises the blood glucose faster (high

Glycemic index) compared to brown rice (whole grain). Moreover, white rice contains less of micronutrients (vitamins and minerals) and dietary fibre. Red coloured rice, and parboiled rice have been mistaken for brown rice. Whether rice or wheat, the whole grain form is the best for people with diabetes.

3 DO OaTS aND RaGI haVING aNy SpECIaL EFFECTS TO hELp CONTROL BLOOD SUGaR?

Oats, ragi, Barley and Bajra – all are millets (minor cereals) and whole grains. unfortunately the oats commonly available today is highly processed (like refined grain) and in addition it is mostly consumed as porridge. Oats and ragi porridge that do not require chewing is quickly digested and raises the blood glucose faster, whereas, oats and whole ragi flour added to the flour in making chappathi or idli/dosa batter could be more beneficial. Oats containing appreciable amounts of soluble fibre is also helpful to reduce the blood cholesterol levels. thus the form in which oats and ragi prepared is important for them to have beneficial effects.

4 whaT IS ThE GLyCEMIC INDEx OF FOOD?

Glycemic index (GI) is a concept that applies to foods containing high amount of carbohydrates. GI ranks the food based on its ability to raise the blood glucose compared to glucose drink (GI of glucose set to a scale of 100). It is the property of food tested with real foods in real people. GI can be influenced by the method

of preparation (boiling, steaming, roasting, mashing), addition of other ingredients (eg. added dal lowers GI). rice when mashed

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or double boiled for preparations like khitchidi or pongal would be likely to show higher GI than rice normally cooked. GI is not the only way to chose healthy food choices and one must look at several components of food. thus a food with lower GI, low in fat, sugar and salt and high in dietary fibre would be the best food while a low GI, high fat food is obviously not as healthy.

5 hOw CaN ONE CUT DOwN ON SaLT wIThOUT FOOD TaSTING BLaND?

recent population survey from our centre indicated that we all eat more salt than we need. this isn’t just the salt we add at the table or in cooking. there’s also the salt added to food by manufacturers (as a preservative and flavour enhancer). Although we all need to cut down on salt, it is particularly important if one already has high blood pressure. It is recommended that one may reduce the intake of salt rather than replacing it with one of the low sodium alternatives available. One can’t take the salt out of manufactured foods but where there is a choice one can select foods that have less salt added. It is easier to get used to a lower salt intake if one cuts down gradually. Instead the food flavour can be enhanced with herbs and spices such as coriander, mint leaves, lime, pepper and jeera (cumin) powder.

6 CaN ONE ChOOSE SpECIaL DIaBETIC FOODS? there is no need for anyone with diabetes to eat special diabetic

foods like cookies, chocolate, jelly/jam or sweets. Diabetic foods often cost a lot more, and tend to be just as high in fat and calories as ordinary products. they usually contain a bulk sweetener, such as fructose or sorbitol, which can have a laxative effect. Diabetic foods offer no special benefit to people with diabetes. Remember that all confectionery, cakes and cookies are high in fat and calories and their intake needs to be limited.

7 whaT aRE ThE aDVaNTaGES aND DISaDVaNTaGES OF USING aRTIFICIaL SwEETENERS By a DIaBETIC

pERSON? For a diabetic person who has a craving for sweets, sweetened products that use artificial sweeteners are an option as this may help curb heir sweet craving. Artificial sweeteners are referred as sugar free or low-calorie sweeteners, sugar substitutes, or non-nutritive sweeteners. they can be used to sweeten food and drinks and hence are lower in Calories compared to sugar. However, one should also remember that foods containing artificial sweeteners would still contain calories coming from carbohydrates, fats and protein from the various ingredients used in the food preparation. For example the Indian sweet -Gulab Jamun, the sugar in it may be replaced with artificial sweetener but it is fried in oil or ghee (clarified butter) and hence high in fat. People with diabetes assume that these special foods are meant for them and hence chances of consuming greater portion size is likely and this would add up to excess calories from fat.

As the sweetening power of artificial sweetener is many times more intense than regular sugar, only a small amount is needed when they are used. Some of the artificial sweeteners that have been tested and approved by the u.s. Food and Drug Administration (FDA) include: acesulfame potassium (also called acesulfame k- brand names –sunett, sweet one), aspartame (nutrasweet and Equal), saccharin (sweet ‘n low), sucralose

6-7(splenda), and stevia / rebaudioside – a table top sweetener (stevia, A sweet leaf).

8 CaN a DIaBETIC DRINk aLCOhOL?Alcohol provide empty calories (calories without any vitamins

and minerals) like sugar. In addition, the accompaniments that goes with alcohol are usually high fat snacks like roasted peanuts, chips etc. therefore, moderate use of alcohol is recommended.

9 whaT aBOUT ThE FOODS wITh ‘SpECIaL EFFECT’ FOR BLOOD GLUCOSE LOwERING pOTENTIaL?

Foods such as bitter gourd or Jambu seed are popular in India as antidiabetic agents. like any other vegetable bitter gourd is good and also high in fibre. The myth to take bitter gourd juice on empty stomach to control diabetes misses the point that bitter gourd juice cannot take care of the entire day’s diet filled with lot of sweets and fats. However, fenugreek has been proven to have functional ingredients that could lower blood glucose. Hence fenugreek can be used in meal preparations such as sprinkling in idli/dosa batter, sambhar, dal, chutneys and rotis. One needs to understand that on the whole a balanced diet (appropriate to one’s body weight alone with adequate physical activity is very important.

10 whICh IS ThE BEST COOkING OIL?there is no single oil that can be recommended, although

olive oil and canola (rapeseed oil) are considered the best. One needs to remember that all fats and oils provide 9 calories per gram (this includes the best quality oils too). Hence both quality and quantity of oils and fats are important for a healthy diet. traditional oils such as groundnut, sesame and blended oils (eg., sunflower and rice bran) are the good choices.

11 whaT aRE ThE BENEFICIaL EFFECTS OF LEGUMES / pULSES FOR DIaBETIC paTIENTS?

Pulses and legumes are low in G.I, rich in fibre, protein and micronutrients. The soluble fibres contained in these legumes helps in controlling blood glucose and cholesterol, and improve satiety. legumes can be incorporated in the regular recipes such as idli, dosa, chappathi and rice etc to reduce the glycemic index and thereby reduces the postprandial blood glucose spikes and this reduce the demand on insulin secretion by the pancreas.

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DIeT – THe maInsTay oF manaGInG TyPe 2 DIabeTes

c oncepts of diet in diabetes have changed from initial carbohydrate-restricted diet to high carbohydrate

and high fibre diet and thereafter to improved quality of carbohydrates in terms of their low glycemic index. An ideal diet should consist of carbohydrates of low glycemic index, mono and polyunsaturated fats with minimum saturated and transfats, average protein, high fibre and with meals spaced evenly through the day. Better metabolic outcome is achieved not only by weight reduction but also by energy restriction and/or increased physical activity. unfortunately, in the last few decades, the culture of consuming whole grain of low glycemic index and physically active life has changed to using refined grains of high glycemic index along with sedentary lifestyle. this has resulted in an increasing prevalence of diabetes in India. this article emphasizes that every normal individual should follow an ideal diet and exercise pattern. Diabetic individuals may at most need small modification.

DR. y. k. aMDEkaR, M.D., D.C.H., HOnOrAry PrOFEssOr OF PAEDIAtrICs,InstItutE OF CHIlD HEAltH, GrAnt MEDICAl COllEGE, MuMBAI.

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“India has made great advances in various fields such as nuclear power, aerospace, self sufficiency in dairy and food production. But it has a long way to go when it comes to addressing basic issues such as infant mortality, malnutrition among the children etc.

Heinz nutrition Foundation India (HnFI) with the support of our global Heinz nutrition Foundation has been spearheading the micro nutrient program by supplying and distributing Nurturemate – an iron fortified micronutrient powder in one gram sachets that helps alleviate the chronic presence of anemia among our children. Anemia results in underdevelopment of various faculties and reduction in immunity. Anemia not only affects the individual concerned but it is accepted that the overall GDP is affected because of poorer performance by anemic individuals.

HnFI is presently supporting a study in Cuddalore, conducted by Directorate of Public Health and Preventive Medicine, tamil nadu. the project involves administering approx. 5,500 children in the backward villages of Cuddalore with nurturemate along with their normal food and closely monitoring the progress. the outcome of the study would further help us prove the efficacy and acceptability of Nurturemate and expand such similar programs in other parts of the state/of India”.

HEAlTH MinisTER M.R.K. PAnnEERsElvAM, AT A WoRKsHoP on MicRo nuTRiEnTs in cHEnnAi REcEnTly.(FRoM lEFT: MR. P. JAgAnnivAs DiR. HnFi, DR. KAnAgAsABAi DME, DR. PoRKAiPAnDiAn DPH&PM,MR. v. MoHAn DiR. HiPl, MR. M R K PAnnEERsElvAM, HEAlTH MinisTER AnDMs. giRiJA vAiDyAnATHAn Mission DiREcToR, nRHM.)

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