People having diabetes must aim to include a good source of protein and fibre in every meal to blunt the glucose response of the meal
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Diabetes is an ever-increasing condition worldwide. India is home to 77 million people with diabetes and is expected to increase to 134 million people by 2045 as per International Diabetes Federation (IDF) 2019. The current pandemic situation coupled with changes in diet and lifestyle such as increased calorie consumption, irregular sleep pattern, increased stress levels and poor physical activity has further worsened the diabetes situation.
India is also undergoing rapid transition in dietary habits, resulting in excess consumption of calories, saturated fats, trans-fats, simple sugars, sodium and low intake of fibre. Another observation from several surveys has been that Indian diets are mostly low in protein with 9 out of 10 Indians consuming a diet deficient in protein. Nutrition therapy forms the basis in diabetes management. Two key nutrients that need focus in diabetes management are protein and fibre, besides taking care other nutrition principles for the management of diabetes.
Protein is a versatile macronutrient and has a vital role to play in our daily life. Proteins are indispensable as they make up the framework of body defence systems, antibodies, enzymes and hormones. Besides playing a key role in functioning of the body, protein also has other benefits for people with diabetes. Protein increases satiety of a meal, resulting in lower food intake. Metabolizing protein in body also burns more calories.
Thus, higher protein intake could lead to lower calorie intake.
Dietary fibre is a type of carbohydrate which is found in plant-based foods. It does not get absorbed or digested by human enzymes, but plays an important role in maintaining good health. There are two types of dietary fibre – soluble and insoluble.
Most foods contain both these types but are usually rich in one type compared to the other. Increased intake of protein and fibre rich foods can help in controlling blood glucose levels and lowering HBA1c. Many studies have shown role of high protein and fibre in lowering the glycemic index of a meal and therefore prevent post prandial blood glucose surge. Studies have also shown that if you eat protein and fibre first followed by carbohydrates or starch, the post meal blood glucose levels are better controlled.
For example, if you have salad or soup with chicken, fish, paneer, curd, buttermilk or sprouts first followed by rice or chapatti, the post-meal blood glucose level spike will be blunted.
Apart from managing the blood glucose level, proteins also have a key role in improving immunity which is compromised in individuals with diabetes. Fibre also helps to boost immunity as it acts like a prebiotic, helping to improve the gut microbiota. People with diabetes are more likely to develop cardiovascular disease.
Evidence shows that increasing fibre intake, especially cereal and whole grains, can help reduce the risk of high triglyceride, cholesterol levels and blood pressure. Dietary fibre absorbs fluid, increases the bulk of waste matter, making stools softer and easier to pass. Foods higher in soluble fibre have a specific role in reducing blood cholesterol levels.
Another advantage of protein and fibre is that they provide good satiety, help control appetite and therefore have a beneficial effect on weight loss which has a role to play especially in management of type 2 diabetes.
As per the Research Society for the Study of Diabetes (RSSDI) protein intake should be maintained at about 15 percent of the total calorie intake and fibre at 25-40g per day. Fibre intake can be increased by incorporating soluble fibre rich foods such as oats, barley, fruits and vegetables, nuts, beans, pulses, soya and lentils; insoluble fibre rich foods such as whole grains, legumes, nuts, seeds and the skin of some fruit and vegetables.
Protein rich foods sources are eggs, lean meat, fish, milk, curd, paneer, sprouts, dal, soybean, soy chunks, soy granules and nuts. Along with adequate quantity of protein, good quality protein consumption is equally important.
Some vegetarian protein sources like legumes, dals, nuts are incomplete proteins i.e. they do not contain all the nine essential amino acids. One needs to combine these protein sources with other food groups such that together they provide all the required amino acids such as Grains + Dals, Dals/Grains + Nuts/Seeds, Legumes/Grains + Dairy E.g. Dal + Rice, Khichdi, Milk + Cereal.
People having diabetes must aim to include a good source of protein and fibre in every meal to blunt the glucose response of the meal. A wholesome, balanced and nutritious diet with emphasis on protein, fibre other essential nutrients can help in improving the glycemic control and improve the overall quality of life.
Professor Paturi V Rao former senior professor and head, Department of Endocrinology and Metabolism, Nizam’s Institute of Medical Sciences University and Hyderabad Patron, Research Society for the Study of Diabetes in India
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