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REVIEW ARTICLE
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 27-35

The role of fruits, vegetables, and spices in diabetes


Department of Pharmacy, GRD (P.G) Institute of Management and Technology, 214-Rajpur, Dehradun, (U.K.), India

Date of Submission22-Nov-2010
Date of Acceptance16-Dec-2010
Date of Web Publication11-Mar-2011

Correspondence Address:
Mohammad Asif
Department of Pharmacy, GRD (PG), Institute of Management and Technology, 214, Rajpur Road, Dehradun
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.77527

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   Abstract 

Diabetes has exploded in a majority of areas in the world. Healthy eating, as a strategy for controlling diabetes, and promoting walking, exercise, and other physical activities is advised. The main aim of the treatment of both types of diabetes is to achieve near normal blood glucose and blood pressure levels. This, together with a healthy lifestyle, will help to improve the well-being of the patients, as also protect them against long-term damage to the eyes, kidneys, nerves, heart, and major arteries. An attempt has been made in this review to focus on traditional uses and their multivalent actions as being health promoting, as well as putative therapeutic agents, especially in diabetes mellitus. Fruits, vegetables, and dietary spices represent a hope that is potentially very high, to limit harmful effects of them. They also influence various systems in the body, with diverse metabolic and physiological actions. They are helpful in various chronic diseases and have played a crucial role in the management of diabetes mellitus and form an important part of one's staple diet. They provide nutritional substances like dietary fiber, vitamins, minerals, and so on, which are essential for a balanced diet. The dietary pattern has beneficial effects on both human health development and treatment of various diseases, and hence, promoting adherence to this pattern is of considerable importance to public health.

Keywords: Diabetes mellitus, diet, diseases, fibers, fruits, spices, vegetables


How to cite this article:
Asif M. The role of fruits, vegetables, and spices in diabetes. Int J Nutr Pharmacol Neurol Dis 2011;1:27-35

How to cite this URL:
Asif M. The role of fruits, vegetables, and spices in diabetes. Int J Nutr Pharmacol Neurol Dis [serial online] 2011 [cited 2017 Aug 17];1:27-35. Available from: http://www.ijnpnd.com/text.asp?2011/1/1/27/77527


   Introduction Top


Diabetes mellitus is a non-communicable global disease and a major cause of morbidity and mortality and is increasing in prevalence in many populations all over the world, although the prevalence rate differs from country to country. The most common form of diabetes is non-insulin-dependent diabetes mellitus (NIDDM) or Type-2 diabetes, comprising over 90% of the cases. Diabetes, particularly type-2 diabetes, is one of the fastest growing public health problems in the world. It has been estimated that the number of diabetes sufferers in the world will double from the current value during the next 25 years. According to the World Health Organization (WHO), the number of diabetics will increase by 170%, by 2025.[1] It is a condition difficult to treat and expensive to manage. [2] The amount and type of food consumed is a fundamental determinant of human health. Diet is one of the major factors now linked to a wide range of diseases, including diabetes. Diet constitutes a crucial aspect of the overall management of diabetes, which may involve diet alone, diet with oral hypoglycemic drugs, or diet with insulin. Diet is individualized depending on age, weight, occupation, and so on. Dietary guidelines exist for the management of the diabetic population, in order to promote an overall nutritional well-being, glycemic control, and prevent or ameliorate diabetes-related complications. This, together with a healthy lifestyle, will help to improve their well-being and protect them against long-term damage to the eyes, kidneys, nerves, heart, and major arteries. [3] In diabetic patients, the control of complex carbohydrates and dietary fiber intake will lead to lower serum triglycerides and cholesterol levels. Individuals with type-2 diabetes are at a high risk of developing a range of debilitating complications that can lead to disability and premature death, for example, cardiovascular disease, peripheral vascular disease, nephropathy, and changes to the retina and blindness, which impose significant medical and economic burdens. Genetic susceptibility and environmental influences seem to be the most important factors responsible for the development of this condition. [4],[5],[6],[7]

Drug, diet, fruit, and spice therapies are the major approaches used for treatment and control of diabetes mellitus. This review attempts to focus on the traditional use of fruits, vegetables, and dietary spices, based on factual research evidence of their multivalent actions as health promoting dietary additives as well as putative therapeutic agents. [8] Spices are food adjuncts that have been used as flavoring and coloring agents and as preservatives for thousands of years. Spices have also been recognized to possess medicinal properties and their use in traditional systems of medicine has been on record for a long time. These beneficial, physiological effects also have the potential of possible therapeutic application in a variety of disease conditions. Healthy eating, as a strategy for controlling diabetes, and promoting walking, exercise, and other physical activities is advised. However, of late, with a drastic increase in physical inactivity, obesity and type-2 diabetes have been observed; a fact which indicates that obesity and physical inactivity may constitute the main reasons for the increasing burden of diabetes. [9],[10],[11],[12]


   Diabetes Top


Diabetes is a disorder of carbohydrate metabolism in which the body does not use the sugars in food in the usual way, and is characterized by high blood glucose level and glycosuria, resulting from the dysfunction of pancreatic beta cells and insulin resistance. Normally, some of the food we digest is changed into glucose or sugar, which the body uses for fuel. Blood carries glucose to the cells where a hormone called insulin allows it to enter the cells. Diabetics produce too little insulin or none at all, or cannot use insulin properly. In advanced stages of diabetes, the metabolism of proteins and lipids is also altered. Many factors such as heredity, age, obesity, diet, sex, sedentary lifestyle, socioeconomic status, hypertension, and various other stresses are involved in the etiology of diabetes mellitus. Diabetes is a condition that affects the way the body uses food. Insulin helps the blood glucose to enter the body cells, where it can be used for energy. When one has diabetes, their body makes little or no insulin, or the insulin does not work properly. Without insulin to help the blood glucose enter body cells, glucose builds up in the blood and the body cells do not get the energy they need. Over time, high blood glucose can cause serious complications. It can damage the eyes, kidneys, and nerves, and also increase the risk of heart disease and high blood pressure. There are two main types of diabetes, type 1 and type 2. The main symptoms of untreated diabetes are increased thirst, going to the washroom frequently - especially at night - extreme tiredness, weight loss, genital itching or regular episodes of thrush, and blurred vision. [13],[14]

Type-1 diabetes

Type-1 diabetes or childhood-onset diabetes or insulin dependent diabetes (IDD) is less common than type-2 diabetes. Only about 5 to 10% of people with diabetes have type-1 diabetes. In type-1 diabetes, the pancreas cannot make insulin. The pancreas contains beta cells that make insulin. Sometimes, the beta cells get destroyed. Many factors can destroy the beta cells. Some people have a genetic tendency toward type-1 diabetes, but in most people with type-1 diabetes, the immune system commits a mistake. Cells that should protect the body instead attack and destroy the beta cells. Without the beta cells, the pancreas cannot make insulin and glucose builds up in the blood. Without insulin, the cell membranes keep the sugar out. Symptoms of type-1 diabetes develop rapidly and the symptoms are caused by high blood glucose. The warning signs may includes, rapid weight loss without trying, frequent urination, increased hunger, increased thirst, blurred vision, and tiredness. The goal of type-1 diabetes treatment is to lower the blood glucose with insulin, a diabetic meal plan, and physical activity. This type of diabetes usually appears before the age of 40. It is treated by insulin injections and diet, and regular exercise is recommended. [15],[16]

Type-2 diabetes

Type-2 or non-insulin-dependent (NIDD) diabetes is more common than type-1 diabetes adult-onset; about 90 to 95% of the people with diabetes have this type. In type-2 diabetes, either the pancreas does not make enough insulin, or the body cells do not respond to insulin (known as insulin resistance). Symptoms of type-2 diabetes develop slowly. Many people with type-2 diabetes do not know they have it until they go to the doctor for a complication. By the time type-2 diabetes is diagnosed, the patient could have had high blood glucose levels for 7 to 10 years. In this form, there may be plenty of insulin in the bloodstream, but the cells are resistant to it. Glucose cannot easily get into the cells, and it backs up in the bloodstream. Most Type-2 diabetics are older adults, overweight, and have a blood relative who has the disease, and it usually appears in people over the age of 40, although it often appears before the age of 40 in South Asian and African-Caribbean people. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination, and blurred vision. In the long run, they are at risk for heart disease, kidney problems, disorders of vision, nerve damage, and other difficulties. It is treated by diet, exercise, medications, and insulin injections. Keeping weight down and increasing physical activity will help most people delay or prevent Type-2 diabetes. Uncontrolled diabetes can lead to a number of health issues, including kidney failure, blindness, heart disease, and stroke. However, with proper testing, treatment, and lifestyle changes, Type-2 diabetes can be controlled. [17],[18]

Gestational diabetes

The third type of diabetes, called gestational diabetes, occurs in some pregnant women. The symptoms and treatment will mimic that of the Type-2 diabetic. It usually disappears after childbirth. [18]

Insulin

Insulin is a hormone produced by the pancreas. People with type-1 diabetes must take insulin because the beta cells are destroyed and the pancreas can no longer make insulin. It cannot be taken by mouth, as insulin is a protein and the gastrointestinal enzymes would digest it. When one eats, the body breaks down the carbohydrates and sugars into glucose, and the blood glucose levels go up. It is vital for life, as it helps the glucose to enter the cells where it is used as fuel by the body. [5],[6],[17]

Diabetes treatment

Each person needs individualized treatment. Type-2 diabetes always requires insulin, diet, and exercise. Insulin or oral hypoglycemic agents are only prescribed for Type-2 diabetics if diet and exercise alone fail to lower the blood glucose. The diabetics need a doctor and a dietician, and the key to proper control is balancing the glucose and the insulin in the blood. This means adjusting one's diet, activity, and sometimes taking medication. [19],[20]

Diabetic meal plan

However, a balanced diet that includes a wide variety of fruits and vegetables and minimal processed food would be expected to reduce the risk of a range of chronic degenerative illnesses. In addition, a diet rich in unprocessed food makes it easier for the body to regulate appetite, and usually helps people to avoid being overweight / obese. On the other hand, the fast-food diet increases the risk of obesity and type II diabetes. A diabetic meal plan matches calories from foods (carbohydrates, proteins, and fats or oils) to individual body activity and insulin levels. The commonly used foods are, milk, vegetables, fruits, pulses, bread and starch, meat, and fat. These foods contain proteins, fats, and carbohydrates. The meal plan should be based on one receiving 50 to 60 percent of the daily calories from carbohydrates, 15 percent from proteins, and the remainder from fats or oils. If insulin medication is taken, a consistent daily routine is essential. The plan will be set up to balance the carbohydrate and insulin peaks. The WHO recommends a minimum consumption of 5 - 10 portions of fruits and vegetables per day. [21],[22],[23],[24]

Effects of fruits and vegetables on human health

The effects of fruits and vegetables on human health allowed measuring of the enormous stakes. The latest scientific evidence provides even greater support for the role that fruits and vegetables play in helping to protect against different diseases like type-2 diabetes, cancer, heart disease, hypertension, and stroke. These diseases are the main cause of deaths world wide. Increasing the consumption of fruits and vegetables is associated with a decreased risk of such chronic diseases. Fruits constitute a commercially important and nutritionally indispensable food commodity. Being a part of a balanced diet, fruits play a vital role in human nutrition, by supplying the necessary growth regulating factors essential for maintaining normal health. Fruits are widely distributed in nature. Some good things in fruits and vegetables are vitamins, minerals, flavonoids (antioxidants), saponins, polyphenols (antioxidants), carotenoids (vitamin A-like compounds), isothiocyanates (sulfur-containing compounds), and several types of dietary fibers [Table 1].
Table 1: Main foods categories: Include unlimited amounts of grains, legumes, fruits, vegetables

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Fruits, vegetables, and other plant foods tend to be rich in antioxidants and other phytochemicals. Antioxidants consumed in food inhibit damaging reactions within the human body and have a beneficial effect upon health. By reducing free-radical damage, antioxidants reduce inflammation, promote cardiac health, and reduce the risk of neurodegenerative diseases like Alzheimer's and Parkinson's disease. Many studies show that some plant phytochemicals are anticancer; they prevent the growth of some cancer cells. A recent study suggests that plant constituents increase sensitivity to insulin, which may help delay the onset of type-2 diabetes. Many fruits contain salicylate, which is relative to anti-inflammatory drugs (aspirin). Chronic inflammation may be the root cause of degenerative illnesses like heart disease (cholesterol is certainly not the only issue), which can be prevented by eating fruits and vegetables regularly, as they contribute significant and beneficial effects. [25],[26]

Role of fruits in diabetes

Fruits should form an important part of one's staple diet. Whether an individual has type-2 diabetes or not, fruits provide the body with fiber, vitamins, and minerals, which are essential for a complete, balanced diet. If individuals are suffering from type-2 diabetes, they can still enjoy the benefits of fruits, except those that contain high levels of carbohydrates and sugars, which can affect an increase in the blood glucose level. They must include fruits with a low Glycemic Index to control Diabetes 2. The fruits with low Glycemic Index include Cherries, Prunes, Grapefruit, Dried Apricots, Raisins, Peach, Apple, Pear, Strawberries, Plum, Guava, Orange, Grapes, Papaya, Banana, Kiwi, Pineapple, Figs, and Mango. Although watermelon has a high Glycemic Index, the glycemic load per food serving (120 g) is low; it will not have a big effect on blood glucose levels. Therefore, a typical serving, because so much of it is water, contains very little carbohydrate, and thus has a low glycemic load. It should still be eaten in moderation. They must be consumed either raw or cooked, or as juice, but with no added sugar. When buying fruits, try buying them in small pieces. Try to avoid fruit juices instead opt for whole fruits, as they contain more fiber and are more filling. If it is a must, when buying canned fruit juices, one should check the label for the following: 'unsweetened or extra-light,' or 'no sugar added.' Stay away from fruits that are frozen or canned in heavy syrup. [25],[26],[27],[28] [Table 2]
Table 2: Low-glycemic index (enjoy) High-glycemic index (avoid)

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Role of vegetables in diabetes

Vegetables supply vitamins, minerals, and fiber. The best vegetable choices can be found to have low amounts of carbohydrates. The vegetables recommended in a Type-2 Diabetes diet include Broccoli, Lettuce, Spinach, Cabbage, Asparagus, Brussels sprouts, Cauliflower, Radish, Turnip, Mushrooms, Green Peas, Soybean sprouts, Carrots, Onions, Peppers, Green Beans, Eggplant, Celery, Cucumber, Zucchini, Tomatoes, Chilies, and vegetable juice. Consume cooked or uncooked vegetables prepared with little or no fat, and with little or no dressing (or sauces). Opt for fat-free or low-fat dressings on salads, as well as on uncooked vegetables. In the vegetables dish, one can also mix in some chopped garlic or onion. Make use of low-fat broths or water to steam the vegetables. Also, add in some lemon juice or a little vinegar into the vegetables. Another good idea is to sprinkle the vegetables with spices, peppers, and many of the commonly available herbs. If one still wants to add some quantity of fat, make use of soft margarines, olive oil, or canola oil in place of butter or fatty meats. [27],[28],[29]

Role of spices and diabetes mellitus

Spices exert several beneficial physiological effects including the anti-diabetic effect like short-term hypoglycemia and long-term improved glucose tolerance activities. A number of condiments and spices including pepper, asafetida, aloes, ocimum, and eugenol have been ascribed a hypoglycemic action in normal as well as experimentally induced diabetic animal models, as also in humans. Recent studies have, on the basis of animal experimentation as well as clinical trials, studied the effects of spices and their extracts or active constituents in the treatment of diabetes. Fenugreek seeds, garlic, onion, turmeric, cumin seeds, ginger, mustard, curry leaves, and coriander have been reported to possess potential anti-diabetic agents. A comprehensive, but detailed discussion of the hypoglycemic effect on these spices is as follows: Cinnamon and its various spices display insulin-potentiating activity, in vitro, in cinnamon spice and its phenolic extracts. Cinnamon supplementation may thus be important to in vivo glycemic control and insulin sensitivity in humans, not only as an immediate effect, but also in sustaining it for 12 hours. It also significantly delays gastric emptying and profoundly lowers postprandial glycemic response, without any significant effect on the repletion. Oral administration of cumin seeds for six weeks to diabetic rats resulted in a significant reduction in blood glucose and body weight. Curry leaves and mustard: the results of the effect of curry or bay leaf supplementation on lipid glycated protein and amino acids in non-insulin-dependent diabetes mellitus patients indicates a transient reduction in fasting and postprandial blood sugar levels, with no appreciable change in other parameters. Both curry leaves and mustard show a significant hypoglycemic action in experimental rats. There is an increase in the concentration of hepatic glycogen and glycogenesis, as is evident from the decreased activity of glycogen phosphorylase, and gluconeogenic enzymes. Many enzymes of the liver, including gluconeogenic, enzymes, have been reported to be affected by spices both in vitro as well as in vivo, in experimental animals. The use of fenugreek seeds has shown a hypoglycemic effect in NIDDM subjects. Incorporation of fenugreek in the diet produces a significant fall in fasting blood glucose and improvement in glucose tolerance, by improving peripheral glucose utilization. Both garlic and onion have been found to possess hypoglycemic activity. Sumac and black cumin, investigate the hypoglycemic mechanism, and the inhibition of a glycoside hydrolase-alpha amylase may have interest in the treatment and prevention of hyperglycemia and diabetes as well as dyslipidemia and obesity. Administration of turmeric or curcumin to alloxan diabetic rats reduces the blood sugar, hemoglobin, and glycosylated hemoglobin levels. Turmeric and curcumin supplementation also reduces the oxidative stress encountered by these diabetic rats. Moreover, the activity of sorbitol dehydrogenase, which catalyzes the conversion of sorbitol to fructose, is lowered significantly on treatment with turmeric or curcumin.[8],[9],[10]

Dietary approaches to diabetes

Dietary treatment of diabetes is performed to achieve optimal blood glucose and blood lipid concentrations and provide appropriate energy for a reasonable weight, normal growth and development, including during pregnancy and lactation. Prevent delay and treat diabetes-related complications, these will improve health through balanced nutrition. The patients must also attempt to choose their daily foods from starches, vegetables, fruits, and proteins, while limiting the amount of fats. Food can be powerful in preventing and reversing diabetes. However, dietary approaches have changed, as we have learned more about the disease. The traditional approach to diabetes focuses on limiting refined sugars and foods that release sugars during digestion namely; starches, breads, fruits, and so on, with less carbohydrate, and contain an unhealthy amount of fat and protein. Therefore, diabetes experts have taken care to limit fats, especially saturated fats that can raise cholesterol levels, and to limit protein for people with impaired kidney function. The new approach focuses more attention on fat. Fat is a problem for people with diabetes. The more fat there is in the diet, the more difficult it is going to be for insulin to get the glucose into the cells. Conversely, minimizing fat intake and reducing body fat help insulin to do its job much better. Newer treatment programs drastically reduce meats, high-fat dairy products, and oils. At the same time, they increase grains, legumes, fruits, and vegetables. Eat an abundance of fruits and vegetables every day, as a nutritious diet. Eating whole fruits is always better than juices. Drink water instead of regular sodas and fruit drinks; tea, coffee, low-calorie juices and beverages are great. Eat lower glycemic index (G.I) foods that will help the diabetes by keeping control of the blood sugar levels, and not allowing them to go up too much. [30],[31],[32]

Role of fiber fights in type 2 diabetes

A dietary fiber is that part of the plant that cannot be digested in the human body, but it is partially digestable in the colon, for example, a pectic substance. In the general fiber of the plant there is some part that is a carbohydrate, for example, cellulose, hemicellulose, and pectic substance, and some part that is not a carbohydrate, for example, lignin and gum. [29] The data have revealed negative correlations between fiber intake and colon cancer, ischemic heart disease, and diabetes mellitus. [33] Water-soluble dietary fibers can delay sugar digestion and absorption. [31] They reduce the insulin level and hormones in the digestive tract and bring about improvement of insulin sensitivity and glucose utilization. [18],[32] Various bile acid chelation effects of these fibers have also been demonstrated. [35]

The role of fruits and vegetables in the prevention of type-2 diabetes tends to be associated with the fiber found in fruits and vegetables. Dietary fiber helps to slow the release of sugar into the bloodstream, thus helping to keep the blood sugar levels normal. Diets that are high in fiber may be able to help in the management of diabetes. Soluble fiber delays glucose absorption from the small intestine and thus may help prevent the spike in blood glucose levels that follow a meal or snack. The long-term effect may be insignificant, however, due to the many other factors that affect blood glucose. On the other hand diets rich in fiber have a number of important health benefits including helping to promote healthy laxation and decreasing the risk of coronary heart disease. Health authorities recommend increased fiber intake through fruits and vegetables. An adult needs about 30 grams of fiber a day to meet the anticipated new recommendations.

  • Fiber slows down the absorption of food in the gut, resulting in better blood sugar control, which may help prevent diminished blood sugar control and type-2 diabetes later on.
  • Fiber lowers blood triglyceride levels. High triglycerides can damage arteries and increase risk of heart disease.
  • Fiber-rich fruits and vegetables are rich in potassium, which helps lower blood pressure, one of the biggest risk factors of heart disease.
  • Fiber-rich fruits, vegetables, and whole grains are rich in phytochemicals that may have heart-disease fighting properties.
Increase intake of fiber foods

Researchers have found that dietary fiber reduces a diabetic's need for insulin, improves blood-glucose control, lowers blood cholesterol and fat levels, and helps with weight loss. A high-fiber diet (40 grams per day, but start slowly) may help control or prevent diabetes. Not all types of fiber help to control diabetes. 'Water soluble' fiber has a stabilizing effect on blood sugar levels, while 'water-insoluble' fiber does not. A mixture of both is found in plant products. Excellent sources of water-soluble fiber include oat products, peas, beans, pasta, brown rice, falafel, cracked wheat, rye, and fruit. Increase fiber in the diet by eating more whole grain foods, vegetables, fruits, and legumes. Dietary fiber is found in fruits, vegetables, and whole grains and cereals. Load up on beans, vegetables, and fruits. Choose whole grains like barley, oats, quinoa, millet, whole-wheat pasta, and so on. Other important tips for diabetics are eating three regular meals per day, no more than six hours apart. Include small snacks between meals. Eat high-fiber foods, such as, whole and multigrain breads, cereals, pasta and rice; soluble fibers such as oat bran, psyllium, and barley are good. Include whole-grain starchy foods at every meal.

Role of phytate other phytoconstuents in diabetes

Fruits contain a considerable amount of dietary fibers as well as phytate, [26] which modulate glycemia and produce a different glycemic index (GI) of foods. Phytic acid or phytate is inositol phosphate, which occurs naturally in plants as a phosphate linkage. Phytate affects the digestability of starch by combining with protein or with digestive enzymes, which are proteins associated with starch. These foods also contain vitamins, minerals, and antioxidants and have a lower glycemic index. Low glycemic index foods will help to keep the blood sugar levels in the target range. They will also make one feel fuller faster and longer and will help to lower cholesterol levels. Beyond the consumable part of the fresh product, an emphasis was also put on the valorization of the by-products, such as the fruit peels, which could represent precious layers of food, for medicinal or cosmetic purposes and thus generate complimentary added value. [21]

Favor foods with a low glycemic index

The glycemic index identifies foods that increase blood sugar rapidly. This handy tool allows one to favor foods that have a much lesser effect on blood sugar. High-glycemic-index foods include sugar itself, white potatoes, most wheat flour products, and most cold cereals. Glycemic Index (GI) is a scale that ranks foods by how much they raise blood sugar levels. The higher the glycemic index of a food, the more it raises the blood sugar levels. The goal is to include low GI foods in the diet. These include whole grain foods, fruits, and vegetables. High-protein foods (i.e., meat, poultry, fish, eggs, peanut butter, nuts) have a low GI; choose low-fat / lean-protein foods. [22],[23]

Limit sugar and carbohydrte labels in food

Sugar can be used in foods and in baking as part of a healthy diet. This does not mean one needs to eat a sugar-free diet. Eating sugar does not cause diabetes and people with diabetes do not need to have a sugar-free diet. A limited amount of sugar can be eaten as part of a balanced, healthy diet, without it having a harmful effect on the overall blood glucose control. However, use sugar-free, with no added sugar, as sugary drinks can cause blood glucose levels to rise quickly. Sugary drinks and sweets will affect blood glucose levels quickly, so use low-calorie drinks, sugar-free or no added sugar squashes. Sugar in foods may not affect blood glucose levels as much as sugar in drinks. However, remember, foods high in sugar, like cakes and desserts, tend to be higher in fat and calories too. For this reason they should be limited especially if one is trying to lose weight. Foods that contain a small amount of sugar or sugary foods, which one eats in small amounts, will not affect the overall diabetes control significantly. Try to reduce fat and sugar intake. Avoid products enriched with wheat (white) flour, sugar, glucose, fructose or any other form of sugar ingredient. [33]

We know now that carbohydrates (from bread, rice, fruits, and vegetables) and sugars have a similar effect on blood glucose levels. Sugar does not cause blood glucose levels to increase much more rapidly than other carbohydrates. Both kinds increase blood glucose levels at about the same rate. For this reason people with diabetes can have sugar in moderation. The total amount of carbohydrate is the issue, not just sugar. There are some problems with foods high in sugar. Foods high in sugar often do not provide other important nutrients that one needs every day. Foods high in sugar are often high in fat also. If one is trying to lose weight, he / she may want to avoid foods high in sugar. Some artificial sweeteners are safe in moderation, including saccharin, aspartame, acesulfame potassium, and Sucralose. The sugar content on the food label should be less than 10 grams per serving. There has been considerable controversy on the effect of various sources of sugar on blood glucose. A lot more evidence has shown that blood glucose values are not always worsened by sugar in the diet. That is why diabetics are now allowed more sugar.

Sodium salt

Most people eat more salt than they need. Salt can raise blood pressure, which increases the chances for heart disease or stroke. You need less than 1,000 milligrams of sodium per 1,000 calories, and should not consume more than 3,000 milligrams of sodium per day. Having diabetes increases the risk of having high blood pressure. As a result, if one is at a risk for high blood pressure the diabetic meal plan may be modified to be low in sodium. Weight loss will also help lower blood pressure for people who are overweight. One-half teaspoon is equal to about 1,000 milligrams of sodium. Limit foods that are high in sodium. [5],[28]

Focus on glycemic index, fats, and fiber

Without insulin, blood sugars (from the breakdown of foods) cannot get into cells, muscles, and brain for energy. It stays in the blood. Over time, high blood sugar causes damage to the blood vessels and can result in blindness, heart disease, kidney problems, amputations, nerve damage, and erectile dysfunction. By eating lower glycemic index foods, low-fat and high-fiber foods, and exercising regularly, one can avoid severe ups and downs in the blood sugar levels.

Eat more whole grain products, vegetables and fruit, and less fat, salt, alcohol, and caffeine. The more sugar one eats, the higher the blood sugar will be! Always read food labels carefully. Limit sugars within the diet. These include sweets, candy, sugar, jam, honey, syrup, regular soft drinks, and sweetened fruit drinks. Avoid foods that contain a lot of sugar such as cakes, pies, cookies, and many pre-packaged foods. Avoid refined (white) foods such as white sugar, white flour, white bread, pastries, and so on. These have a high glycemic index and will cause the blood sugar levels to spike. [34],[35],[36]


   Discussion Top


The lifestyle modifications of the adoption of a healthy dietary pattern together with physical activity are the most valuable in the prevention of type 2 diabetes. Therefore, emphasis must be given to promoting a healthier lifestyle, [2] and to these findings in order to increase compliance to the lifestyle modifications, especially for high-risk individuals. As a result, promoting adherence to the diet is of considerable public health importance, as this dietary pattern, apart from its various health benefits, is tasty and easy to follow in the long term. [11],[12] Fruits, vegetables, and dietary fibers are very important as part of the diet for health and nutrition. Eat more fruit and vegetables in the diet to provide vitamins and fiber as well as to help keep a balanced overall diet. Fruits and vegetables are very healthy and nutritious as they contain various healthy phytochemicals like vitamin C, provitamine A, minerals, dietry fibers, phytates, and so on. Spices are food adjuncts that have been used as flavoring and coloring agents and as preservatives, and have also been recognized to possess medicinal properties, and their use is seen in traditional systems of medicine for various human disorders, including diabetes. [19],[20]

Fibrous food is advisable for colon cancer, ischemic heart disease and diabetes; these patients should eat more fibrous fruits and vegetables. High-fiber varieties of starchy foods can help to maintain the health of the digestive system and prevent problems such as constipation. However, high fiber does not necessarily mean it is better for diabetes control. Fruits with high phytate must have a high glycemic index. [21] Foods that tend to be absorbed more slowly help to control the blood glucose levels. Diet is an important aspect in the management of a diabetic patient. The diabetic healthcare provider and the patient must understand the basic dietary needs of the patient. Balancing the diet for a diabetic can be challenging. The food choices and eating habits are important in helping to manage diabetes. Eating a balanced diet, managing the weight, and following a healthy lifestyle, together with taking any prescribed medication and monitoring, where appropriate, will benefit the patient's health enormously. Remember, in the long run it is better to make small changes that one feels one can stick with, rather than completely altering the diet and not sticking to it. Taking steps to balance the diet, as outlined in this leaflet, will help one control one's blood glucose levels, blood fat-cholesterol and triglycerides, and blood pressure. It will also help regulate the weight. If one is overweight, losing weight will help control the diabetes and will also reduce the risk of heart disease, high blood pressure, and stroke. At each meal include starchy carbohydrate foods, such as, bread, pasta, chapattis, potatoes, yam, noodles, rice, cassava, and cereals. The amount of carbohydrate one eats is important to control the blood glucose levels. All varieties are fine, but try to include those that are more slowly absorbed (have a lower glycemic index) as these will not affect the blood glucose levels as much. The high fiber varieties of starchy foods will also help to maintain the health of the digestive system and prevent problems such as constipation. Greater awareness and multilevel actions are required for addressing these trends. They must be integrated into agriculture, food, health and education policies. To Avoid Complications with Diabetes the breakfast plate should be one-third fruit, one-third starchy fiber foods, and one-third protein. Lunch and dinner plates should be half vegetables, quarter starchy fiber foods, and quarter protein. Choose whole grains, to increase fiber intake, and low fat. [5],[12],[21],[23]


   Conclusion Top


In conclusion, a diet rich in fruits, vegetables, spices, and their fibers, significantly reduces the risk of type-2 diabetes, cardiovascular diseases, stroke, and some types of cancer, obesity, and Alzheimer's disease. Many different studies have shown that the beneficial effects of a range of different fruits, vegetables, and spices, and their dietary fibers are increasing in importance in chronic diseases, and they have also shown the recently recognized interest in reinforcing their place in the diet, to face these true 'epidemics'. Fruits and vegetables have been recognized as a good source of vitamins and minerals. They have been especially valuable for their ability to prevent vitamin C and vitamin A deficiencies, and dietary fibers have also been used to control digestive problems like constipation. This effect can be further increased by including wholegrain foods, nuts, and certain polyunsaturated oils (e.g., omega-3 fish oils, olive oil) in the diet. A lot more emphasis is put on the importance of the diversity in food, and in particular on fruits and vegetables, like on synergies being able to exist between the components of the same food and between foods. The United State Diabetes Association (USDA), the World Health Organization (WHO), the National Institutes of Health (NIH), and the Canadian Diabetes Association (CDA) recommend that for the prevention of type-2 diabetes encourage the consumption of carbohydrate containing foods such as whole grains, fruits, vegetables, and low-fat milk, with low GI, and a physical workout. The effect of fruits and their components, phytate, and dietary fibers regulate the blood sugar level in diabetic patients. Also suggested is a minimum of five servings per day of fruits and vegetables combined in the diet or a consumption of 400 grams of fruit and vegetables as well as 40 grams of dietary fibers per day.

 
   References Top

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    Tables

  [Table 1], [Table 2]


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