Diabetes which is a condition with high blood glucose levels, is an ever increasing challenge in India. One in seven adults with diabetes is from our country and we have a large population undiagnosed with diabetes (1).
Where do you think we are going wrong?
India is undergoing a rapid nutritional transition. Our dietary patterns are moving towards excess calories, unhealthy fats, refined carbohydrates, and sodium with a low intake of fiber and protein. Meals have been replaced by snacks in modern times and refined, processed foods which are low in fiber are available freely at a cheaper cost than healthier options making them a preferred choice. Such unhealthy dietary practices coupled with a sedentary lifestyle have led to an increase in obesity and lifestyle-related disorders such as pre-diabetes, type 2 diabetes, heart disease, cancer, etc (2).
So what can we change?
We need to get back to our traditional roots and consume a wholesome balanced diet which comprises of good quality carbohydrates, adequate amount of protein, healthy fats, and lesser intake of processed, refined foods high in sugar, salt, and trans fats (3).
Another dietary ingredient which has been seen as a boon for diabetes is ‘Fiber’. Many studies have shown that adequate fiber intake reduces the risk of developing diabetes and helps to improve blood glucose levels and HbA1c (quarterly test for assessing blood glucose control) in individuals with pre-diabetes and diabetes (4). Fiber also helps in lowering blood cholesterol levels and reduces the risk of heart disease (4).
Fiber gives you a feeling of satiety leading to suppression of appetite, promotes weight loss, and improves the way the body uses insulin. Moreover, fiber decreases the glycaemic index of the meal which helps lower post-meal blood glucose levels (4).
Starting a meal with a fiber and protein source followed by carbohydrate-containing foods has been shown to blunt the post-meal blood glucose spikes. This practice can be replicated in all meals, for example, you can have a salad or vegetable first with protein like yogurt/paneer/chicken/ egg/ fish/ or dal and then the remaining meal to achieve glucose levels in the desired target range (5).
Soluble fiber absorbs water as it passes through the gastrointestinal tract, forming a viscous gel. The bulking effect increases the time the food stays in the stomach and hence improves satiety, and promotes weight loss. It also slows glucose absorption and therefore lowers post-meal blood glucose levels. It helps improve gut health and reduces bad cholesterol (6).
Insoluble fiber on the other hand is not water-soluble. It does not form a gel, however, it adds bulk to the faeces, has a laxative effect improving bowel movement.
Where is fiber found?
Sources of soluble fiber are fruits and vegetables, such as oranges, apples, berries, carrots, beans, lentils; nuts, oat, and barley products.
Sources of insoluble fiber are fruit skins; cucumbers, tomatoes, grain hull, brown rice, legumes, nuts, almonds, whole grain, and bran products
How much fiber do we need?
World Health Organisation has recommended a total dietary fiber of more than 25 g/day for management of diseases like diabetes (4).
How can we add more fiber into our daily diet?
- Include more plant-based foods such as fresh, local, seasonal fruits and vegetables, wholegrain cereals, millets, legumes, nuts, and seeds to meet your fiber requirements.
- Add fiber to every meal, be it breakfast, main meals and snacks.
- Brown rice, unpolished rice, sweet potato, whole pulses, unpolished millets like pearl millet, sorghum, finger millet, foxtail millet, barnyard millet, oats, barley are rich sources of fiber as well as provide essential micronutrients which are beneficial to health.
- Have a rainbow with different colors of at least 4-5 servings of fruits and vegetables in a day to get the fiber as well as an antioxidant boost to the diet.
- Start your meal with an unstrained soup or a salad and then move on to main meals. Ensure half your plate is filled with vegetables.
- Choose whole fruit over fruit juice and rolled/ steel cut oats over instant oats to get the benefit of fiber.
- Swap unhealthy processed foods made from refined flour and sugars with whole-grain foods.
- Consult a qualified dietitian who will help plan a diet ensuring you meet your nutrition and fiber requirements (7).
Another novel and convenient way to add fiber in the diet is by consuming supplements containing soluble fiber like Diabetes Plus which has dual blend fiber nutriose and fibersol. Nutriose forms a viscous gel in the stomach, delays passage of foods to the intestine and therefore helps to feel full for a longer period while (10,11) Fibersol combines with food and releases glucose slowly.
This way it helps to manage blood glucose levels. (12)
While increasing fiber in the diet is important, it is recommended to step it up gradually. Adding a lot of fiber to the diet too quickly can result in unpleasant side effects like bloating, abdominal discomfort, and flatulence. Always couple fiber with adequate water to avoid these side effects (8).
Including adequate amounts of fiber in the daily diet by incorporating fiber-rich food sources may prevent the onset of lifestyle diseases and their complications.
Time to fill up on fiber and keep diabetes at bay
1. International Diabetes Federation (IDF) Regional Factsheet, Diabetes in South-East Asia in 2021, Available at https://diabetesatlas.org/idfawp/resource- files/2021/11/IDF-Atlas-Factsheet-2021_SEA.pdf.
2. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44:1094–101. [PubMed] [Google Scholar]
3. The Nutrition Source, What to Eat, Harvard School of Public Health. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/.
4. Puri S, Krishnaswamy S, Joshi S, Urooj A, Sharma N. Dietary Fiber and Health. Position of The Indian Dietetic Association. 2018.
5. Alpana P. Shukla et.al, Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels, Diabetes Care 2015 Jul; 38(7): e98-e99.
6. Fiber, The Nutrition Source, Harvard School of Public Health. https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/.
7. How to get more fiber in your diet, Staying Health, Harvard Health Publishing, https://www.health.harvard.edu/staying-healthy/how-to-get-more-fiber-in-your-diet.
8. Dietary fiber: Essential for a healthy diet, Nutrition and healthy eating, https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983.
9. Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67(4):188-205.
10. Slavin JL, Savarino V, Paredes-Diaz A, Fotopoulos G. A review of the role of soluble fiber in health with specific reference to wheat dextrin. J Int Med Res. 2009 Jan-Feb;37(1):1-17.
11. Lefranc-Millot C. Nutriose a useful soluble fibre for added nutritional value. Nutr Bull 2008; 33:234-9.
12. Fibersol-2TM: A soluble, non-digestive, starch-derived dietary fiber. In: McCleary B, Prosky L, eds. Advanced Dietary fiber Technology. Oxford, UK: Blackwell Science; 2001:509-23.
Engagement- An interview with a nutritionist to talk about the lifestyle changes and nutrition advice she gives to her patients
Interview Questions for Nutritionist
- What foods do you advise for a person having diabetes?
- Which foods increase blood glucose levels?
- Can a person having diabetes drink fruit juice?
- Should a person having diabetes avoid white rice?
- Why is fiber important to incorporate into the diet?
- Which foods should be included in the diet to increase fiber intake?