Diabetes and Dietary Carbohydrates: Smart Carb Choices for Blood Glucose Management| NutraManagement

Welcome to Neutron Management. Today we discuss about diabetes and dietary carbohydrates. We know that diabetes is mainly of carbohydrate metabolic disorders. So, from the dietary control of diabetes, the main regulatory process is the inclusion of carbohydrate in the diet. So, what strategy we will adopt for carbohydrate inclusion in the diet to control the diabetes? Because at present, the strategy which is adopted for controlling diabetes is the lifestyle and food style. This is the advanced mode of diabetes treatment. Advanced mode of diabetes treatment is the lifestyle and food style management. This is the best treatment process of diabetes. Now, the carbohydrate nature, that is the inclusion of the food items in the diet for controlling blood glucose level is the most important regulatory key in this concern. We know that diabetes is a chronic metabolic disorder which is associated with the high blood glucose levels. There is elevation in the fasting blood glucose as well as postprandial blood glucose. There is also elevation of the glycemic index containing food item and glycated hemoglobin level is also elevated. Normal glycated hemoglobin is about 5.4% and the diabetes that glycemic, that glycated hemoglobin level is also increased. So, the carbohydrate inclusion that is regulated here by controlling glycemic index. Now, if we study the type of diabetes, which is type 1, type 2 mainly. Type 1 you know that it is insulin dependent diabetes mainly and type 2 that is non-insulin dependent diabetes mellitus. Type 1 is mainly IDDM and type 2 is NIDDM. Other one that the gestational diabetes, another one that is known as the mitochondrial diabetes, that is the diabetes which is transmitted from mother to next generation. And this transmission is mainly through mitochondrial gene because in oocyte, we also receive this diabetes gene from oocyte through mitochondria. Not from sperm, that is not from father through mitochondria because in fertilization process only the nucleus of the sperm is required where there is no mitochondria. So, when the diabetes is transmitted from previous generation to next generation through mitochondria mainly through oocyte, that is known as the mitochondrial diabetes. Now, for controlling blood glucose level in diabetes, we will not include the simple carbohydrate in the diet. We mainly include complex carbohydrate because this complex carbohydrate would be digested at a very slow rate and due to the slow rate of digestion, the absorption of the glucose from the intestine would be low and that can control the blood glucose level anyway. So, in our daily diet, we exclude the simple carbohydrate as well as oligosaccharides and mainly we include the complex carbohydrate along with some amount of the resistant starch as well as dietary fiber. Now, how carbohydrate intake influence the blood sugar level? This is the most important question because if the glycemic index, that is the most important sensor for the glucose delivery in our digestive tract from food to the bloodstream, the glycemic index is the important regulatory process for glucose supply from dietary item to bloodstream. That means glycemic index is focused on how quickly a carbohydrate-containing food reaches the blood glucose, that is known as the glycemic index, which is generally compared against glucose intake value. And glycemic index, on the basis of this glycemic index, foods are divided into three categories. Low glycemic index having the glycemic index value less than equal to 55, less than equal to 55. If the glycemic index value is less than equal to 55, then it is known as the low glycemic index. If the glycemic index value is 56 to 69, then it is known as the medium glycemic index. And if it is high, that is more than 70, it is known as the high glycemic index. As for example, apple, lentils, these are also low glycemic index foodstuff, but the white bread is a high glycemic index foodstuff. So, in our diet, we exclude the high glycemic index and include the low glycemic index. Now, glycemic load is also another sensor. Glycemic load is another sensor in this concern. The glycemic load mainly indicates how much a typical serving of food reaches blood glucose. Glycemic load is the glycemic index into grams of available carbohydrate per serving divided by 100, that is known as the glycemic load. So, glycemic index, glycemic index that is compared with pure glucose, the rate of the blood glucose elevation compared to pure glucose, that is known as the glycemic index. And glycemic load, it is the product of, that is the multiplication of glycemic index into grams of available carbohydrate per serving divided by 100. If the glycemic load value is less than equal to 10, then it is referred as low glycemic load. If this value is 11 to 19, then it is known as the medium glycemic load. If that value is more than equal to 20, then it is known as high glycemic load, high glycemic load. So, in the choice of the food, we not only consider the glycemic index, but we consider the glycemic load. We mainly include the food item having low glycemic load, though the glycemic index may be the moderate or the high. As for example, if we consider watermelon, watermelon has a high glycemic index, that is the value is near about 72. So, it is the high glycemic index. But if we studied glycemic load, it is about 4 to 5, that means less than 10. So, it is the low glycemic load. And thereby, the watermelon has limited capacity to raise the blood glucose level. And in diabetes, watermelon may be supplied, though its glycemic index is also high. But if we study the white rice, the glycemic index is moderate to high, its glycemic load is also high. So, if we consume excess amount of the white rice, then the blood glucose level would be elevated. So, we consider the food item having low glycemic load with low or moderate glycemic index, it would be the best rule for the food choice. Side by side, we do not include the boiled carbohydrate. Half-boiled carbohydrate or the raw carbohydrate, if we include in our diet, it would be better for blood glucose regulation. In case of the boiled carbohydrate, the chemical bonding, that is the glycosidic bonds become very loose. And thereby, amyloidic enzymes can able to cleave this bond very quickly that raise the glucose absorption as well as the blood glucose elevation. On the other hand, if we consume the raw carbohydrate or you may say that is the half-boiled carbohydrate or unboiled carbohydrate, then the glycemic, that is the chemical bonding, one-sixth glycosidic bonding, one-fourth glycosidic bonding are very rigid, are very strong. And the amyloidic enzymes which are present in our gastrointestinal tract are unable to cleave that glycosidic bond clearly and so glucose absorption would be checked. So, third rule is that for carbohydrate inclusion, we mainly prefer the raw carbohydrate and unboiled carbohydrate, half-boiled carbohydrate, not the boiled carbohydrate. Similarly, the whole grains, whole fruits, not the fruit juice, total vegetables, legumes, fiber-rich food, we must include. Dietary fiber-rich food is one of the best items for dietary management of diabetes because these dietary fibers are not digested in our GI tract, but it gives the satiety and therefore it controls the food consumption rate. Side-by-side, the dietary fiber by fermentation can be able to produce short-chain fatty acids and that short-chain fatty acids can be able to stimulate the beta cell for insulin synthesis and secretion. Side-by-side, this short-chain fatty acid can be able to overcome the insulin resistance and these are also most important process for diabetes recovery. Now, carbohydrate counting. Carbohydrate counting is the method for planning meals and insulin adjustment. That means what is the dose of the insulin that we provide to the patient. On the basis of the meal planning, the insulin dose should be adjusted and that is known as the carbohydrate counting. So, carbohydrate counting is another strategy for blood glucose regulation in diabetes, which is the combination of the meal planning by the inclusion of the carbohydrate-rich food and exclusion of the high glycemic index, high glycemic load-containing food and the insulin dose which is required for blood glucose management. Therefore, the key takeaway is the balanced carbohydrate intake improves glycemic control and health and this is the most important food style for diabetic patients.