What is type 2 diabetes?
It is a long-lasting health condition that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces so the body becomes resistant to insulin. Insulin is a hormone that regulates blood sugar.
What are its causes?
Common causes are obesity, high carbohydrate or high sugar diet, less physical activity and stress. Majority of the people with diabetes have type 2 diabetes. Insulin resistance with impaired function of cells in pancreas leads to development of diabetes. Too much fat and refined carbohydrates in the diet with not enough fibre also contribute to diabetes. Inactivity and excess weight go hand in hand. Muscle cells have more insulin receptors than fat cells so individual can decrease insulin resistance by exercising. With chronic stress there is high cortisol levels leading to increased insulin.
Foods with high glycaemic index and glycaemic load (e.g. refined goods) can gradually lead to obesity and cause type 2 diabetes.
Glycaemic index indicates how quickly a carbohydrate digests and gets released as glucose into the bloodstream which is measured by blood sugars. It uses 50 gm portion of carbohydrate. Scale of 0-100 grades this effect. It is preferable to eat low GI foods. The limitation is it only measures the effect of carbohydrate on raising blood sugars but fails to address serving size of carbohydrates. Example water melon has a very high glycaemic index of 72 but only contains 5 percent carbohydrate by weight.
Glycaemic load determines how a food will affect blood sugars. It is a measure of number of carbohydrates in serving making it stronger predictor of what will happen to blood sugars. Example watermelon has very low glycaemic load of 5 while the corn tortilla ranks high at 25.
Refined foods have high glycaemic index and glycaemic load scores. Whole foods have low glycaemic load scores despite containing similar amounts of carbohydrate.
What are its effects?
- Non-alcoholic fatty liver disease (NAFLD) is common in type 2 diabetes as 80% of people with diabetes have fat in the liver. Liver plays an important role in regulating the body`s blood sugar and the build of fat makes it harder to control fasting glucose levels. It also makes the body more resistant to insulin leading to type 2 diabetes.
- Polycystic ovarian syndrome (PCOS) – Women who have PCOS have a higher risk of developing type 2 diabetes as they are more insulin resistant which means pancreas have to produce more insulin to keep the blood sugar normal.
How to address type 2 diabetes?
Nutritionally balanced diet aimed at maintaining blood sugar levels within range and supporting a healthy weight is key. Though one can include most foods in diabetic diet, one needs to pay most attention to types of carbohydrates in order to prevent spikes or increases in blood sugar. Foods high in simple carbohydrates mostly from added sugars like cane sugar, brown sugar, maple syrup, honey and refined grains like white flour, white rice will cause blood sugars to rise more quickly than foods that contain fibre such as whole wheat, oats, fruits and vegetables.
Basic guidelines with diabetes
- Achieve a healthy weight (BMI of 18.5-25) – Too much fat in the abdomen and around the organs called visceral fat is the main cause of insulin resistance. Losing weight can help reverse insulin resistance and prevent type 2 diabetes. A 30 percent reduction in calorie intake results in 30 percent calorie expenditure resulting in weight loss.
- Meet protein requirement of 0.8-1g protein/ kg of ideal body weight – Include good quality protein like eggs, chicken, fish, nuts, seeds, lentils, beans, tofu, milk and milk products or cereal pulse combination like khichdi, idli, dosa which makes it a complete protein.
- Choose foods with a low glycaemic load as they slow down the release of glucose into the bloodstream. Beans, pulses, fish, poultry, eggs, vegetables, fruits, dairy, fats have lower glycaemic load than grains. Wholegrains like brown rice, quinoa, millets have lower glycaemic load than white starches, sugars, alcohol.
- Eat vegetables – Most vegetables being low in calories and carbohydrates are rich in fibre and micronutrients such as vitamin C, folic acid, vitamin B complex, iron and calcium. Root vegetables such as potato, yam, colocasia root are higher in calories and carbs compared to other vegetables so are not recommended in the diabetic plan.
- Choose deep and bright coloured fruits, vegetables, herbs and drink green tea as they are all rich in antioxidants that will help reduce inflammation and oxidative stress in diabetes.
- Include omega 3 fats for the membrane insulin receptors and to improve inflammation. Eat oily fishes like herring, mackerel, salmon, sardines three times a week. Also include walnuts, flaxseed, hemp, chia, pumpkin seeds and their oils.
- Include foods containing micronutrients like chromium, magnesium and zinc. Chromium rich foods are broccoli, oats, barley, green beans. Foods high in magnesium are spinach, nuts, beans, tuna, brown rice, dark chocolate and zinc rich foods are beans, nutritional yeast, oats, nuts and seeds.
- Cinnamon, fenugreek and bitter gourd helps in lowering blood sugars in diabetes.
- Apple cider vinegar – The acetic acid in vinegar may help to slow down the conversion of complex carbohydrates into sugar in the blood. It also keeps the system alkaline to manage diabetes and blood glucose levels.
- Taking regular exercise is an excellent way to relieve stress and lower cortisol levels. It can also release endorphins and improve mood.
- Managing stress and having good quality sleep – Mindfulness meditation helps become aware of our thoughts and be in present.