Sunday, 9 March 2014

Diabetes: Making the right choices

It is best to choose healthy carbohydrate-rich foods, with at least half of the carhdrates as whole grains.

It is best to choose healthy carbohydrate-rich foods, with at least half of the carhdrates as whole grains.

Does having diabetes mean you have to forgo all that delicious food?

MALAYSIA is renowned as a food haven. We have a diverse range of cuisines to tease our palates.

Can delicious food still be a choice for people with diabetes? To answer this, let’s review how diabetes is managed with dietary modification over the past 30 years.

Healthy eating is part of an important component of a healthy lifestyle for people with diabetes. Do they need to choose foods differently from the general population? Not really.

If you were to compare the dietary recommendations for the general population and those for people with diabetes, you will find that they are actually similar.

Both recommend foods that are low in fat, salt and sugar, and high in fibre. Foods are to be chosen from all major food groups – grains, fruits, vegetables, dairy and protein-rich foods. The key principles in making healthy food choices are balance, variety and moderation.

A major difference between the two dietary recommendations is people with diabetes must regulate their carbohydrate intake carefully.

Carbohydrate from food gets digested to form glucose, and this results in an increase in blood glucose.

Food rich in carbohydrate include grains, rice, noodles, bread, starchy vegetables, fruits, beans, milk and sugary foods.

Thus, consuming a consistent amount of carbohydrate distributed throughout the day with regular meals helps to keep blood glucose levels more constant.

People with diabetes should avoid skipping meals. They should also not have double servings of carbohydrate rich food, e.g. two bowls of rice instead of one for lunch, and adjust for it following dinner with no carbohydrate intake.

This helps prevent wide and undesirable fluctuations of blood glucose levels. Thus, regular food quantity and timing is as important as the amount of food consumed.

Is sugar allowed?

What about sugars and sweets? For many years, people with diabetes were told to avoid sugar, sweets and some starches. Now, it is known that a small amount of sucrose or table sugar can be incorporated into a healthy eating plan, provided the carbohydrate contribution is accounted for.

When table sugar is used judiciously, it can help to make some food more appealing and improve its palatability, for example, adding half a teaspoon of sugar in a bowl of oats porridge with skim milk.

Research has shown that small amounts of table sugar does not raise blood glucose as rapidly as we used to think. However, foods or drinks concentrated with sugar are not encouraged as they do not provide much nutritional value. This is more so for those who are overweight or have high triglyceride (a certain type of abnormal blood cholesterol pattern) in their blood.

Carbohydrates – the new sin?

Carbohydrates from different types of food are absorbed into the blood stream at different rates. Complex carbohydrates, e.g. whole grain, is absorbed slower than simple sugars, and do not spike up blood glucose level after eating.

Nevertheless, total carbohydrate intake rather than the type of carbohydrate has a greater impact on blood glucose. Hence, people with diabetes need to keep track of the amount of carbohydrate they consume to keep to the recommended portions within the meal plan.

It is best to choose healthy carbohydrate-rich foods, with at least half of the carbohydrates as whole grains. Regular fruit intake is also encouraged.

Monitoring carbohydrate intake by carbohydrate counting, or experience-based estimation, remains a key strategy in blood glucose control. Use carbohydrate food exchange lists, nutrition information on food labels and nutrition food databases as tools to help in carbohydrate counting.

You can also use a healthy food plate model as a visual concept to help control carbohydrate intake through portion control and balance. (See illustration – Healthy Food Plate Model).

A healthy balanced meal should include plenty of vegetables, with moderate amounts of carbohydrate and some protein.

Food choices should be low in fat, especially saturated fats (e.g. curries rich in coconut milk, fatty meats).

Saturated fats, trans fats (which act like saturated fats) and cholesterol from food increase blood cholesterol levels. High blood cholesterol levels increase the risk of heart problems, a major cause of death for most people with diabetes.

In addition, gram for gram, fats provide more than double the energy compared to protein and carbohydrates. All types of fats (including healthy unsaturated fats) are dense in energy.

For those who need to reduce weight, reduce caloric intake by lowering fat intake. Choose foods prepared with little oil or fats, and those of a lower fat alternative, e.g. skim milk or low fat milk replacing full cream milk.

Over the past 30 years, dietary recommendations for people with diabetes have been revised. Current recommendations have moved away from focusing on what foods to avoid, to adopting smart healthy eating as part of a healthy lifestyle.

Make the right food choices at the right portions and have them regularly at the right time. For the change to be sustainable, foods should remain interesting, appealing, and taste delicious.

Lee Lai Fun is dietician and diabetes educator. Dr Hew Fen Lee is a consultant endocrinologist. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

Tags / Keywords: Health , column , diabetes , diet


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