Diabetic diet

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Diabetic diet

The diet most often recommended for people who suffer from diabetes mellitus is high in dietary fiber, especially soluble fiber, but low in fat (especially saturated fat). Patients may be encouraged to reduce their intake of carbohydrates that have a high glycemic index. However, in cases of hypoglycemia, they are advised to have food or drink that can raise blood glucose quickly, followed by a long-acting carbohydrate (such as rye bread) to prevent risk of further hypoglycemia.

Early history of diabetic diet

There has been long history of dietary treatment of diabetes mellitus - as Ramachandran & Viswanathan (1998) note, dietary treatment of diabetes mellitus was used in Egypt as long ago as 3, 500 B.C., and was used in India by Susrate and Charaka some 2, 500 years ago. In the eighteenth century, these authors note, John Rollo argued that calorie restriction in the diabetic diet could reduce glycosuria in diabetes. However, more modern history of the diabetic diet may begin with Frederick Madison Allen, who, in the days before insulin was discovered, recommended that people with diabetes ate only a low-calorie diet to prevent ketoacidosis from killing them. This was an approach which did not actually cure diabetes, it merely extended life by a limited period. The first use of insulin by Frederick Banting in 1922 changed all that, and at last allowed patients more flexibility in their eating.

Exchange scheme

In the 1950s, the American Diabetes Association, in conjunction with the U.S. Public Health Service, brought forth the "exchange scheme". This was a scheme that allowed people to swap foods of similar nutritional value (e.g. carbohydrate) for another, so, for example, if wishing to have more than normal carbohydrates for pudding, one could cut back on potatoes in one's first course. The exchange scheme was revised in 1976, 1986 and 1995 (Chalmers & Peterson, 1999, p85). However, not all diabetes dietitians today recommend the exchange scheme. Instead, they are likely to recommend a typical healthy diet: one high in fiber, with a variety of fruit and vegetables, and low in both sugar and fat, especially saturated fat. A diet that is high in plant fibre was recommended by James Anderson (Anderson & Ward, 1979; cited in Murray & Pizzorno, 1990). This may be understood as continuation of the work of Burkitt and Trowell on dietary fibre, which in turn, may be understood as a continuation of the work of Price (Murray & Pizzorno, 1990). Murray and Pizzorno discusses the high-carbohydrate, high-plant fibre diet (HCF diet) in connection with diabetes (Murray & Pizzorno, 1990, pp277ff.).

Carbohydrates

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better, while others claim benefits for a high-fiber, 75% carbohydrate diet.

An article summarizing the view of the American Diabetes Association contains the statement "Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake." Sucrose does not increase glycemia more than the same number of calories taken as starch. Although it is not recommended to use fructose as a sweetener, fruit should not be avoided because of its fructose content. Benefits may be obtained by consumption of dietary fibre in conjunction with carbohydrate; as Francis (1987) points out, evidence suggests that carbohydrate consumed with dietary fibre will have a less major impact on glycemic rise than the same amount of carbohydrate consumed alone.

Low-carbohydrate alternatives

Some studies show low carbohydrate diets may be effective in dietary management of type 2 diabetes.

Dr. Richard K. Bernstein has a diet plan that is substantially different from the plan recommended here and he is harshly critical of the standard ADA diet plan for diabetics. His plan includes very limited carbohydrate intake (30 grams per day) along with frequent blood glucose monitoring, and regular strenuous muscle-building exercise, and for diabetics using insulin, frequent small insulin injections if needed. His treatment target is "near normal blood sugars" all the time.

Vegan alternative

Recent studies have shown that a vegan diet may also be effective in managing type 2 diabetes.

Timing of meals

For people with diabetes, healthy eating is not simply a matter of "what one eats", but also when one eats. The question of how long before a meal one should inject insulin is asked in Sonsken, Fox and Judd (1998). The answer is that it depends upon the type of insulin one takes and whether it is long, medium or quick-acting insulin. If patients check their blood glucose at bedtime and find that it is low, it is advisable that they take some long-acting carbohydrate before retiring to bed to prevent night-time hypoglycemia.

Special diabetes products

Recently, Diabetes UK have warned against purchase of products that are specially made for people with diabetes, on the grounds that:

They may be expensive,
They may contain high levels of fat
They may confer no special benefits to people who suffer from diabetes.

Alcohol and drugs

It is recommended that alcohol and some other drugs are used in moderation. Alcohol inhibits the glycogenesis in the liver and some drugs inhibit hunger symptoms. This, together with impaired judgment, memory and concentration caused by some drugs can lead to hypoglycemia.

References

Bowling, S. (1995). Everyday Diabetic Cookbook. Grub Street. ISBN 1898697256. - Published in conjunction with the British Diabetic Association.
Chalmers, K. & Peterson, A. (1999). Sixteen Myths of a Diabetic Diet. American Diabetes Association. ISBN 1-58040-031-0.
British Diabetic Association Festive Foods and Easy Entertaining. British Diabetic Association. ISBN 1-899288-70-8.
Govindi, A. & Myers, J. (1995). Recipes for Health: Diabetes. Low fat, low sugar, carbohydrate counted recipes for the management of diabetes.. London: Thorsons/Harper Collins. ISBN 0-7225-3139-7.
Murray, M. & Pizzorno, J. (1990). Encyclopaedia of Natural Medicine. London: Littlebrown and Company. ISBN: 1-85605-498-5
Ramachandran, A. & Viswanathan, M. (1998). Dietary management of diabetes mellitus in India and South Asia. In K.G.M.M. Alberti, R.A. DeFronzo & P. Zimmet (eds.). International textbook of diabetes mellitus. pp773-777. Chichester : Wiley, 1997.
(1998). Diabetes at Your Fingertips. Fourth Edition, London: Class Publishing. ISBN 1-872362-79-6.