DIET should be the mainstay of all diabetic management!

In order to ensure compliance, the prescribed diet should be individualised. It must be realistic, flexible, and take into consideration the patient's likes and dislikes, to as large an extent as possible, and must suit the patient's life style. It is important to educate the patient about the basic requirements of the diet and judge compliance at regular intervals.

INTERESTINGLY, OUR TRADITIONAL INDIAN DIETS, WITH SLIGHT MODIFICATION, ARE CLOSE TO WHAT IS NOW CONSIDERED IDEAL DIABETIC DIETS!

PATIENTS DO NOT HAVE TO MAKE ANY "MAJOR CHANGES TO THEIR USUAL DIETARY HABITS, WITH THE EXCEPTION OF AVOIDING SAMPLE SUGARS AND ADJUSTING THE FAT INTAKE.

THIS ALLOWS INCREASING COMPLIANCE WITH THE DIET ADVISE!

AVOID simple carbohydrates like sugar, sweets, jaggery, honey, etc., as they tend to cause a sharp rise in the blood glucose levels.

Total calories allowed to an individual will depend on the present weight and the targeted optimal weight.

• Carbohydrates should constitute around 60-70% of the total calories.

• The carbohydrates should be in the form of complex polysaccharides (starch) and contain adequate amount of fibers.

• The widespread misconception that carbohydrates (in any form) should not be eaten by diabetics should be removed. Carbohydrates in the form of simple sugars need restriction.

• It is important to emphasise that rice, potatoes and fruits are not contraindicated in a diabetic diet.

• Most traditional Indian diets usually meet with this requirement.

• There does not seem to be any need for additional fibers supplement in the form of a pharmaceutical prescription.

• Protein intake should be approx. 0.8 gms/kg ideal body weight; this usually comprises around 12-18% of the calorie intake.

• The requirements for proteins may be increased in catabolic states, pregnancy, lactation and in some elderly patients.

• Protein intake may need to be restricted in patients with nephropathy.

• Fats should be restricted to around 20-25% of the total calories.

• One should preferably take equal amounts of saturated, mono-unsaturated and polyunsaturated fats.

• It is a misconception to feel that polyunsaturated fats are safe and can be taken freely.

• Many foods contains fats; this "invisible fat" should be taken into account when estimating the total fat intake.

• It is advisable to restrict the total intake of cooking fats to less than 6% of the total energy intake; in simple terms, food should be cooked in the least amount of oil or ghee; if feasible, food should be preferably be grilled, steamed or broiled, microwaved, rather than fried.

• The total intake of cholesterol should be restricted to around 300 mg per day.

• The fat intake may need to be further modified if associated dyslipidemia is present.

• Recent evidence suggests that attention must be paid to the intake of essential fatty acids (EFAs) such as omega-6 (w6) and omega-3 (w3) fatty acids.

• These EFAs make to be derived from food and cannot be made in the body.

• Not only must they be eaten in adequate amounts, but the relative ratio is around 4:1.

• Indian diets usually contain too much of w6 fatty acids and little, if any, of w3 fatty acids. This is due to the fact that most foods are rich in w6 fatty acids and poor in w3 fatty acids which is mostly found in fish.

• Indian diets usually give a ratio of around 40:1.

• The disproportionate ratio is made worse by the use of the so called "safe" cooking oils such as safflower oil and sunflower oil, in which the ratio is around 150:1!

• If this ratio is to be brought down to near optimal levels, then it would be essential to do a RETHINK about the advised mode of cooking media, and possibly revert to our traditional cooking media, which although they may not contain w3 fatty acids, also are poor in w6 fatty acids.

• Although these traditional cooking media like mustard oil, coconut oil and ghee may be relatively high in their saturated fat content, their poor content of w6 fatty acids allows a more optimal w6/w3 intake, especially when associated with increased w3 intake in the form of fish or w3 supplements.

• The saturated fat content of these cooking media are offset by the benefits of the more optimal w6/w3 intake, especially if the total use of the cooking media is minimised.

• This change over to some of the more traditional cooking media, accompanied by the use of as little as possible of the cooking medium, allows a diet with a ratio of around 8:1 which is close to optimal.

• Salt restriction is necessary in patients with associated hypertension, cardiac failure and fluid overload.

• These can be eaten by diabetics in moderate amounts. Raw and partially ripe fruits are preferable.

• If consumed, alcohol should be used in moderation.

• It should be avoided in all diabetics who are overweight and on hypocaloric diets, on biguanides, or in those who have high triglyceride levels. All other contraindications to alcohol intake also apply to diabetics.

• In those diabetics, who are allowed alcohol, this should be restricted to less than 5% of the total calories. Generally, this is equivalent to about 45 ml of whisky or related alcoholic drinks.

• Wine, sherry and beer are best avoided.