Type-2 diabetes is a major, non-communicable disease with increasing prevalence at a global level. Type-2 diabetes results when the body does not make enough insulin or the body cannot use the insulin it produces. Type-2 diabetes is the leading cause of premature deaths. Improperly managed, it can lead to a number of health issues, including heart diseases, stroke, kidney disease, blindness, nerve damage, leg and foot amputations, and death. Type-2 diabetes or adult-onset diabetes is most common type of diabetes, usually begins when a person is in his or her mid-50s, but diabetes is not inevitable. Minor changes in your lifestyle can greatly reduce your chances of getting this disease. Therefore, in order to prevent this condition, action should be taken regarding the modifiable factors that influence its development-lifestyle and dietary habits. However, with proper testing, treatment and lifestyle changes, healthy eating as a strategy, promote walking, exercise, and other physical activities have beneficial effects on human health and prevention or treatment of diabetes, promoting adherence to this pattern is of considerable public health importance.
Diabetes mellitus or type-2 diabetes, is one of the major non-communicable and fastest growing public health problems in the world, is a condition difficult to treat and expensive to manage. It has been estimated that the number of diabetes sufferers in the world will double from the current value of about 190 million to 325 million during the next 25 years. Individuals with type-2 diabetes are at a high risk of developing a range of debilitating complications such as cardiovascular disease, peripheral vascular disease, nephropathy, changes to the retina and blindness that can lead to disability and premature death. It also imposes important medical and economic burdens. Genetic susceptibility and environmental influences seem to be the most important factors responsible for the development of this condition. However, a drastic increase of physical inactivity, obesity, and type-2 diabetes has been recently observed. The fact indicates that obesity and physical inactivity may constitute the main reasons for the increasing burden of diabetes in the developed world.
Fortunately, because environmental factors are modifiable, disease manifestation from these factors is largely preventable. Diet is one of the major factors now linked to a wide range of diseases including diabetes. The amount and type of food consumed is a fundamental determinant of human health. Diet constitutes a crucial aspect of the overall management of diabetes, which may involve diet alone, diet with oral hypoglycemic drugs, or diet with insulin. Diet is individualized depending on age, weight, gender, health condition, and occupation etc. The dietary guidelines as used in this review are sets of advisory statements that give quick dietary advice for the management of the diabetic population in order to promote overall nutritional well-being, glycogenic control, and prevent or ameliorate diabetes-related complications.
Objectives of dietary treatment of diabetes
The aims of dietary treatment of diabetes are:
To achieve optimal blood glucose concentrations.
To achieve optimal blood lipid concentrations.
To provide appropriate energy for reasonable weight, normal growth, and development, including during pregnancy and lactation.
To prevent, delay, and treat diabetes-related complications.
To improve health through balanced nutrition.
The attempts to adhere to the conventional food measurements in order to comply with prescriptions of the so-called ‘diabetic diet’ usually result in unnecessary restrictions, overindulgence, or monotonous consumption of certain food items, e.g., unripe plantain/beans. This is a consequence of illiteracy, poverty, and cultural misconceptions about the role of diet in the management of diabetes. This is usually the most problematic aspect of diabetes care. The usually recommended daily energy intake for the non-obese diabetic patient is between 1500 and 2500 calories per day, the average allowance being 2000 k calories per day. The recommendation for the overweight diabetic patient is between 800 and 1500 k calories per day, while the underweight (including growing children and adolescents) should be allowed at least 2500 k calories/day.
DIET AND DIABETES
The beneficial effect of the dietary pattern on diabetes mellitus and glucose metabolism in general and traditional food pattern was associated with a significant reduction in the risk of developing type-2 diabetes. The dietary pattern emphasizes a consumption of fat primarily from foods high in unsaturated fatty acids, and encourages daily consumption of fruits, vegetables, low fat dairy products and whole grains, low consumption of fish, poultry, tree nuts, legumes, very less consumption of red meat. The composition of diet is one of the best known dietary patterns for its beneficial effects on human health that may act beneficially against the development of type-2 diabetes, including reduced oxidative stress and insulin resistance. High consumption of vegetables, fruits, legumes, nuts, fish, cereals and oil leads to a high ratio of monounsaturated fatty acids to saturated fatty acids, a low intake of trans fatty acids, and high ingestion of dietary fiber, antioxidants, polyphenols. The diets are characterized by a low degree of energy density overall; such diet prevent weight gain and exert a protective effect on the development of type-2 diabetes, a condition that is partially mediated through weight maintenance. Greater adherence to the diet in combination with light physical activity was associated with lower odds of having diabetes after adjustment for various factors. On the other hand, a paleolithic diet (i.e., a diet consisting of lean meat, fish, shellfish, fruits and vegetables, roots, eggs and nuts, but not grains, dairy products, salt or refined fats, and sugar) was associated with marked improvement of glucose tolerance while control subjects who were advised to follow a diet did not significantly improve their glucose tolerance despite decreases in weight and waist circumference. People most likely to get diabetes are: People who are overweight, upper-body obesity, have a family history of diabetes, age 40 or older, and women (50% more often than men).
TREATMENTS OF DIABETES
Each person needs individualized treatment. Type-1 diabetes always requires insulin, diet, and exercise. Type-2 diabetics require insulin or oral hypoglycemic agents (medication that helps lower blood sugar), if diet and exercise alone fail to lower blood glucose. If you have diabetes, you need to have a medical team (doctor, nutritionist, and health educator or nurse) working with you. Whichever type of diabetes you have, the key to proper control is balancing the glucose and the insulin in the blood. This means adjusting your diet, activity, and sometimes taking medication.
GENERAL DIETARY GUIDELINES
Modern dietary management of diabetes essentially involves modifications of the quality and quantity of food to be taken by the diabetic patient. The following guidelines are applicable to diabetes irrespective of type, weight status, age, gender, or occupation.
Most of the carbohydrate consumed should be in the form of starch (polysaccharides) such as maize, rice, beans, bread, potatoes etc.
All refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees, etc.) and honey should be avoided, except during severe illness or episodes of hypoglycemia. These foods contain simple sugar, which is easily absorbed causing rapid rise in blood sugar.
Non-nutritive sweeteners, e.g., Canderel, saccharine, NutraSweet, aspartame are suitable sugar substitutes for diabetic subjects.
Animal fat such as butter, lard, egg yolk, and other foods high in saturated fatty acids and cholesterol should be reduced to a minimum and be replaced with vegetable oils, particularly polyunsaturated fats.
Salt should be reduced whether hypertensive or not.
Protein (fish, meat, beans, crab, crayfish, soyabean, chicken, etc.) and salt are restricted for those with diabetic nephropathy.
Cigarette smoking should be avoided by diabetic patients. Alcohol should be taken only in moderation.
The items allowed for free consumption include: Water, green leafy vegetables, tomatoes, onions, cucumber, aubergine, peppers, vegetable salad without cream. Any brand of tea, coffee, or drinks that contain very low or no calories.
For patients too ill to eat solid food, a fluid or semi-solid diet should be substituted (papaya, soya bean, custard, etc.).
Patients treated with insulin or certain oral hypoglycemic agents, e.g., sulfonylureas must be advised to eat regularly and often to prevent hypoglycemia- 3 meals a day plus suitable snacks in between, e.g., fresh fruits.
Small meals spaced over the day, rather than 1 or 2 big meals, are helpful in avoiding post-pyramidal peaks in blood sugar.
When overweight diabetic patients drop some weight by trimming down ‘serving sizes’ and calories, insulin sensitivity improves, thereby optimizing drug therapy. The fundamental principle behind maintenance of body weight is the energy balance. This group should be encouraged to maintain their current weight by: Maintaining current ‘serving sizes,’ eating about the same amount of food each day, eating at about the same times each day, taking their drugs at the same times each day, and exercising at the same times each day. These patients should also endeavor to choose their daily foods from starches, vegetables, fruits, and protein, while limiting the amount of fats.
Dietary approaches to diabetes
Food can be powerful in preventing and reversing diabetes. However, dietary approaches have changed as we have learned more about the disease. The traditional approach to diabetes focuses on limiting refined sugars and foods that release sugars during digestion-starches, breads, fruits, etc. With carbohydrates reduced, the diet may contain an unhealthful amount of fat and protein. Therefore, diabetes experts have taken care to limit fats- especially saturated fats that can raise cholesterol levels, and to limit protein for people with impaired kidney function. The new approach focuses more attention on fat. Fat is a problem for people with diabetes. The more fat there is in the diet, the harder time insulin has in getting glucose into the cells. Conversely, minimizing fat intake and reducing body fat help insulin do its job much better. Newer treatment programs drastically reduce meats, high-fat dairy products, and oils. At the same time, they increase grains, legumes, fruits, and vegetables. The study found that patients on oral medications and patients on insulin were able to get off of their medications after some days on a near-vegetarian diet and exercise program. During 2 and 3-year follow-ups, most people with diabetes treated with this regimen have retained their gains. The dietary changes are simple, but profound, and they work.
EFFECTS OF THE FRUIT AND VEGETABLES ON THE HUMAN HEALTH
Fruits constitute a commercially important and nutritionally indispensable food commodity. Being a part of a balanced diet, fruits play a vital role in human nutrition by supplying the necessary growth regulating factors essential for maintaining normal health. They have been especially valuable for their ability to prevent vitamin C and vitamin A deficiencies. Fruits and vegetables are good source of vitamins, minerals, flavonoids (anti-oxidants), saponins, polyphenols, carotenoids (vitamin A-like compounds), isothiocyanates (sulfur-containing compounds), and several types of dietary fibers. The fruits and vegetables not only prevent malnutrition but also help in maintaining optimum health through a host of chemical components that are still being identified, tested, and measured. They prevent various chronic diseases like stroke, hypertension, birth defects, cataracts, diabetes, heart disease, cancers, diverticulosis, obstructive pulmonary disease (asthma and bronchitis), and obesity etc. Diets that are high in insoluble fiber may offer the best protection against this disease. Fruits and vegetables are high in cellulose-a type of insoluble fiber. Diets that are high in fiber may be able to help in the management of diabetes. Soluble fiber delays glucose absorption from the small intestine and thus may help prevent the spike in blood glucose levels that follow a meal or snack. The long-term effect may be insignificant, however, due to the many other factors that affect blood glucose. The effects of the fruit and vegetables on the human health allowed to once again measuring the enormous stakes. More and more emphasis is put on the importance of the diversity of food, and in particular of the fruit and vegetables. This new and effective approach to diabetes is remarkably simple. Here are 4 simple steps to managing your blood sugar (and weight, blood pressure, and cholesterol) with diet.