Health conscious people do not have to rely on specialist foods, so why should diabetics? The answer, according to Azmina Govindji, chief dietician for the British Diabetic Association, is that they do not. A healthy diet is healthy for everyone, she says.
“Special products are misused a lot by diabetics,” Mrs Govindji says. “Diabetic products are generally no lower in fat or calories than their non-diabetic equivalents. Since many diabetics are required to lose weight, such products are not helpful at all.”
Additionally, they were often more expensive and some of the older formulations contained high levels of sorbitol, a sweetener that can act as a laxative. However, there was a more important reason: “We feel that diabetics do not need a special diet at all that they can have normal, healthy food from an ordinary supermarket. Encouraging them to have special foods from a special shop is isolating them and that is not necessary.”
Even in home baking, the use of special sugars is no longer recommended by the British Diabetic Association, she says. “Studies have shown that small amounts of ordinary sugar, when mixed in with high-fiber ingredients, do not have a detrimental effect on their blood sugar.”
However, those who are unable to take drinks such as tea or coffee without sugar may be advised to use sweeteners, such as aspartame (for example, Candarel) or saccaharin (Sweet n’ Low), instead.
An important aspect of controlling diabetes is keeping weight steady. “Any weight loss should be slow and steady, rather than going for any of these special formula diets,” Mrs Govindji says.
That means avoiding such low-calorie regimes as the Cambridge diet. “Particularly if you are diabetic, you need a slow, steady supply of carbohydrates during the day.”
The British Diabetic Association’s advice is to cut down on fat, because it contains a high concentration of calories, and alcohol, which is high in calories, while increasing the intake of fiber. Many fibrous foods are low in calories, yet are filling, and that can help on a weight-loss program.
People of Asian origin appear to run a higher risk of diabetes, the reason for which is not yet known. Unfortunately, when diagnosed as diabetic, many feel that, as they now have to watch their diets, they ought to change to western foods, believing them to be superior. That is a myth, Mrs. Govindji says.
“The Asian diet can be very healthy. The traditional foods are a good source of protein and are high in fiber, the types of fiber that are best in controlling diabetes.” Lentils, for example, contain a beneficial type of fiber, soluble fiber, and lentils are more widely eaten in Asian diets than in western diets. “We are actually trying to promote Asian eating habits because they are better,” she says.
Dr Paul McKeigue agrees. “In many ways, it is more healthy. The total fat content of the diet of Gujeratis is similar to that of the UK population, but there is less saturated fat and more polyunsaturates,” he says, after a study he undertook at University College, Middlesex School of Medicine.
“I do not think there is anything specific about Indian diets that account for the high rate of diabetes in that group.”
To prevent diabetes, he says it is advisable to reduce the total energy intake and exercise regularly to control obesity. “What matters is if you are over-weight, rather than the things you eat.”
The British Diabetes Association’s advice is to reduce the amount of oil and ghee (clarified butter) used in cooking and to switch to polyunsaturated products, such as sunflower oil and polyunsaturated margarines. Fruit can replace high-fat sweetmeats and semi-skimmed milk can replace full-cream milk.
The association provides guidance on food and diet, whether western or Asian, in leaflets published in English, Vengali, Gujerati, Hindi, Punjabi and Urdu.
As the amount of food needed varies between individuals and depends on age, sex, weight, lifestyle and occupation (sedentary clerical work or physically demanding jobs, for example), those with diabetes should seek nutritional advice, especially when it concerns weight loss.
“They can do this by asking their GP for a referral to the dietician at the local hospital,” Mrs Govindji says.
She is concerned that often family doctors do not refer their patients to dieticians, but instead provided leaflets produced by drug companies or food manufacturers.
There could be a two- to six-week wait for an appointment with a dietician, but it is worth it, she says, as diets can be tailored to specific lifestyles.
“ You may be a business-lunch person or you may be a shift-work person. The dietician can formulate a diet suited to how you live, including the foods you enjoy.”