February 07, 2022

What is the science behind diabetes ?

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Diabetes is a condition where your blood glucose levels remain higher than normal.

Why does this happen?

Several factors can lead to diabetes, the most common ones being genetic factors and bad lifestyle. The risk of diabetes goes up with overweight or obesity and with physical inactivity. In diabetes, the body either cannot produce enough insulin, or the functioning of insulin is affected.

So what does insulin do?

It is a hormone that helps glucose from the food enter into your cells to be used for energy. Thus, if the insulin is not produced by the body (Type 1 diabetes) or is ineffective (Type 2 diabetes), glucose levels in the blood rise, and over the long term, high blood glucose levels can damage various organs of our body.

Do you know ?

As per the lates findings, India is home to more than 74 Million people with diabetes. This is said to be the SECOND-HEIGHEST worldwide. At the globel level India accounts for 1 in 7 of all adult livings with diabetes.

 

Diabesity on the rise

The so called ‘modern’ lifestyle is the one to blame here. Advancement in technology, digitalization and the lockdown have made life more sedentary. Obesity is on the rise and the nutrition transition towards processed and high calorie foods is leading to the ‘diabesity’ (Obesity + Diabetes) epidemic. Excess body fat levels are a major cause of insulin resistance (insulin does not work effectively) as seen commonly in type 2 diabetes (3).

Carbohydrate is an important nutrient in our diet as it is the main source of energy. Carbohydrates are broken down to glucose and have the maximum effect on the           

blood glucose levels. Both the quantity and quality of carbohydrates are linked with the high prevalence of diabetes.

Increased consumption of refined carbohydrates also known as ‘bad carbs’ like refined flour & it’s products (bakery products, processed foods, ready to eat foods), polished white rice, potato and sugar sweetened beverages along with low consumption of protein sources (curd/paneer/non-veg foods/dals & pulses) are among the commonest reasons for increased prevalence of diabetes in India (4). We should be consuming more of the ‘good carbs’ which is complex carbohydrates like those from whole grains eg: whole wheat chapattis, unpolished rice, millets, legumes, pulses and green leafy vegetables. So basically, we need to improve the quality of carbohydrate in our diets by substituting the bad carbs with the good carbs. 

Good Carbs v/s Bad Carbs

The basic difference between the refined or the bad carbs and the complex or the good carbs is that the bad carbs are low on fiber and other micronutrients while the good carbs have fiber along with other vitamins and minerals.

Fiber and its health benefits.

Fiber is a type of carbohydrate which cannot be digested. It is not broken down into sugar unlike the other carbohydrates. Since it passes through the body undigested, it helps to improve satiety and keeps the hunger pangs in check. This way it helps in weight control. Additionally, it reduces the risk of developing diabetes. It helps to improve the blood glucose levels in people having diabetes. It does so by decreasing the glycaemic index (rate at which blood glucose levels rise in the blood) of the meal which helps to blunt the post prandial blood sugar levels. There are two types of fiber: soluble and insoluble fiber. Soluble fiber, as the name suggests, dissolves in water and can help lower blood glucose levels and cholesterol. Some foods with soluble fiber are oats, barley, nuts, beans, lentils, apples, guava etc.   Insoluble fiber, does not dissolve in water and helps to improve bowel movement and adds bulk to the faeces and prevents constipation. Some foods with insoluble fiber are whole grains, legumes, carrots, cucumbers and fruit skins (5).

Fiber is an all-rounder, as it furthermore has a role in reducing cholesterol and high blood pressure levels which is commonly found in people with diabetes (6). As scary as it may sound, if you have diabetes, you are twice as likely to have a heart disease (7).Hence, one should opt for fiber rich foods to foster heart health too.

The general recommendation by WHO for fiber intake is 25g/day(8). Foods which provide good amount of fiber include fruits, vegetables, whole grains, beans and legumes. Fiber supplements like Diabetes Plus have made intake of recommended amount of fiber easy and convenient and beneficial for blood sugar management. It contains soluble fiber and has dual blend fiber nutriose and fibersol*. Nutriose forms a viscous gel in the stomach, delays passage of foods to the intestine and therefore improves satiety(9,10) while fibersol combines with food and slows the release of glucose from the food leading to delay in the absorption of blood glucose.(11) This way it hits two targets of blood sugar control and fulfils 26% fiber requirement with one arrow. 

Diabetes management is all about making some small changes to your way of life. Other than increasing fiber intake in the diet, moderating the overall carbohydrate intake, including adequate proteins, regular physical activity, blood glucose monitoring and following the doctors advise ensures a normal good quality of life. 

References

  1. International Diabetes Federation (IDF) Available at https://www.idf.org/aboutdiabetes/what-is-diabetes.html
  2. 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.
  3. Diabetes.Co.uk. Diabetes and Obesity. Available at https://www.diabetes.co.uk/diabetes-and-obesity.html
  4. Mohan, V., Unnikrishnan, R., Shobana, S., Malavika, M., Anjana, R. M., & Sudha, V. (2018). Are excess carbohydrates the main link to diabetes & its complications in Asians? The Indian journal of medical research, 148(5), 531–538. https://doi.org/10.4103/ijmr.IJMR_1698_18
  5. Harvard T.H. Chan School of Public Health . The Nutrition Source. Fiber . Available at https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/
  6. Liew C. H. (2020). Dietary Fibre for the Prevention of Cardiovascular Disease. Irish medical journal, 113(5), 76.
  7. Diabetes and Your Heart, Centers for Disease Control and Prevention, last updated May 7, 2021, https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html.
  8.  Puri S, Krishnaswamy S, Joshi S, Urooj A, Sharma N. Dietary Fiber and Health. Position of The Indian Dietetic Association. 2018
  9. 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. 
  10. Lefranc-Millot C. Nutriose a useful soluble fibre for added nutritional value. Nutr Bull 2008; 33:234-9. 
  11. 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.
    Disclaimers
    *Journal of Diabetes and Metabolism; 2020 Feb; 11(2): 841.
    NUTRIOSE® is a registered trademark of Roquette Frères
    ^Nutriose® and Fibersol -2 are trade names for Wheat fibre dextrin & Corn fibre dextrin respectively.
    Horlicks Diabetes Plus is not intended to replace any existing medication. It is a nutritional beverage to be consumed as a part of balanced daily diet and exercise.


    Questions & Answers for Diabetologist

    1. What are your thoughts on increasing prevalence of diabetes in India? What are the main causes in your opinion?
    2. In your practice, what is the lowest age group of patients you have come across being diagnosed with type 2 diabetes?
    3. According to you, what is lacking in Indian diet which is increasing risk of developing metabolic issues such as diabetes, heart diseases etc.?
    4. Do you think, fiber has a role to play in managing blood glucose levels?
    5. What do you recommend to increase fiber in diet to your patients?
    6. Do you think use of fiber supplements should be considered for people with diabetes?