Rice has been a staple food across Asian countries. Our ancestors consumed everything from rice and sugar to refined flour and coconut oil. But, presently, there have been numerous concerns and warnings raised over the consumption of various foods especially after processed foods have taken over our eating habits. The do’s and don’ts do make sense when we are living in an era where movement has become minimal, eating habits have taken a reverse gear, and people are leading a sedentary lifestyle. Such restrictions make even more sense when we are talking about people with diabetes as the carbohydrate content in certain foods play a predominant role in determining their GI value.
 
Choosing To Eat Rice with Diabetes
 
Despite the availability of clinical treatments and medications, the diet consumed and the physical activity performed have a major role in keeping our blood sugar levels under control. Many a time, we’ve been suggested to eat foods with a low GI value to keep the total carbs intake under control—this is because carbohydrate-rich foods have the natural tendency to spike blood glucose levels instantly. Those not having a track over their eating habits are at a serious risk over multiple health concerns including heart disease, foot infections, and more.
 
Rice occupies over 20% of the total calorie consumption being the staple food not only in Asian countries but also in African countries. In such a scenario, is there a feasibility for individuals to skip eating rice or reduce its portion intake? Moreover, is it necessary to forego the intake of rice altogether if you suffer from diabetes?
 
The General Advice Over Rice
 
There have been abundant research and studies showing that consumption of high GI foods have the potential to increase the risk of diabetes risk. White rice has a high glycemic index (GI) value (around 64) which means that it can cause increase in blood sugar levels. A study by the British Medical Journal and the Harvard School of Public Health (HSPH) proved that individuals consuming too much of white rice are at an increased risk of diabetes—this means that if you have prediabetes, it is better to be conscious about the rice intake levels.
 
Another study called the Prospective Urban Rural Epidemiology (PURE) did a multi-country research on over 1,00,000 individuals. The results clearly showed that higher consumption of white rice was linked to an increased risk of diabetes, especially in South Asia.
 
All these clearly prove that white rice consumption elevates the risk of type 2 diabetes in individuals.
 
Alternatives to White Rice
 
White rice is the most popular of all but there are different varieties of rice that could be chosen as a better alternative to this. For instance, these days many individuals choose to include quinoa, millets, brown rice, barley, buckwheat, or red rice in their daily diet.
 
While choosing some type of rice, it’s essential to pick a variety that packs ample nutrients and has a lesser GI value. Maybe a cup of cooked brown rice or long-grain rice could be a smart choice as these contain vitamins, nutrients, and fiber besides having a GI value around 55. Traditionally, mankind was used to consuming hand-pounded rice, barley, rye, and maize but now these have been replaced by highly polished white rice. Study results show that substituting white rice with unpolished brown rice decreases glycemic response by 23% and fasting insulin response by 57%. But the major problem is that most individuals are not satisfied with brown rice consumption as it’s not too appealing nor easy to chew and eat.
 
But what makes brown rice a healthy alternative to white rice? It’s mainly because brown rice retains the nutrient-rich germ and bran layer while shelling off its hard out part only. But a word of caution, as brown rice can have high arsenic levels if grown in arsenic-rich areas. Still, the micronutrient and fiber content are higher making it comparatively healthier for people with type 2 diabetes.
 
The Bottomline
 
Rice is not our enemy and people with diabetes aren’t advised to stop the intake of rice altogether. It’s the portion sizes that play a pivotal role in determining the role of white rice in triggering diabetes risk. Instead of filling the plate with 75% of rice, cut it down to 25% and fill the rest with fresh veggies and pulses.
 
Diet quality is important—eating a variety of foods that’s enriched with nutrients including vegetables, fruits, whole grains, nuts, and proteins is healthy for the body.
 
Keep diabetes away by staying healthy and eating a well-balanced diet that’s low in sugar, salt, and fat. Eat rice in moderation, split carbs intake through the day, and choose half the grains as whole grains to enjoy a serving of white rice during the meal.

Coma is a commonly-heard terminology where the individual is in an unconscious state for a prolonged duration due to various reasons. But not many are familiar with the term ‘diabetic coma’ nor even aware of its existence.
 
Diabetic coma is also an unconscious state where the individual isn’t responsive to the surrounding. It is a life-threatening condition that’s generally caused due to too high or too low blood glucose levels. The person is alive but that’s it—there is no response to any kind of stimulation and poses great risks. All these are indeed frightening but with proper steps and precautions it is possible to avoid this condition altogether.
 
Warning Signs/Symptoms
 
The onset of diabetic coma includes having very high blood sugar levels of 600 mg/dL or more resulting in severe dehydration. More commonly affecting people with type 2 diabetes, under this condition, the blood is thicker than usual ketones are not present in the urine—this condition is known as diabetes-related hyperosmolar syndrome.
 
In those with type 1 diabetes, the blood sugar levels fall below 250mg/dL or even lower sometimes. Called as diabetes-related ketoacidosis, the body starts using fatty acids instead of glucose for energy with the presence of ketones in the urine and bloodstream.
 
As the condition is the result of hypo- or hyperglycemia, the symptoms are also different accordingly. The individual has symptoms of high or low blood sugar levels before the onset of diabetic coma.
 
Hypoglycemia-related Symptoms
 

• Anxiety, dizziness, or headache
• Tiredness, weakness, and shakiness
• Confusion
• Blurred vision and difficulties in speaking
• Hunger
• Sweating
• Loss of consciousness

 
Hyperglycemia-related Symptoms
 

• Frequent visits to the restroom
• A constant state of thirst
• Tiredness, drowsiness, and weakness
• Stomach pain
• Nausea
• Dry mouth
• Weakened pulse
• Blurry vision

 
Humans are used to habits and so are our pain-enduring skills. Similarly, having diabetes for a long time can lead to a condition called ‘hypoglycemia unawareness’ where there are no signs/symptoms indicating a drop in the blood glucose levels. But, generally the person feels thirsty continuously and urinates frequently. So, if there are any signs of changes in the sugar levels, it is better to get yourself tested immediately to avoid further complications.
 
Causes of Diabetic Coma
 
The chances of diabetic coma is greater in individuals with type 1 diabetes due to hypoglycemia or ketoacidosis (due to diabetes). But, the condition might occur in individuals with type 2 diabetes also majorly due to hyperosmolar syndrome compared to hypoglycemia or ketoacidosis. Other contributing factors for diabetic coma include consumption of alcohol, medications such as steroids diuretics, or heart medications, illnesses, surgery, improper diabetes management leading to haphazard blood glucose levels, trauma, illegal substance use, careless handling of insulin doses, and kidney failure.
 
Treatment Protocol
 
The treatment agenda mainly depends on the cause of the condition. If very low blood sugar levels are the cause of the problem, the patient is given IV fluids, insulin, and administered glucagon to reverse the effects of insulin. In case of high blood sugar levels, administering IV fluids, supplements such as phosphate, potassium, and sodium, and insulin helps in treating the patient.
 
Are There Possibilities of Preventing the Disease?
 
Common sense does tell us that maintaining blood glucose levels in admissible ranges is the best way to avoid the occurrence of any drastic conditions. Some ways in which we can avoid diabetic coma include:
 

• Keep checking blood sugar levels regularly and keeping glucose levels well under target ranges. For this, you must first understand your target range and also have knowledge about the steps that must be followed when the numbers go away from this range
• Always have some glucose tabs, some fruit juice, or fruit handy to consume immediately when your blood glucose levels go down
• Never indulge in overconsumption of alcohol
• Be aware of how to use a glucagon kit and also teach the same to your caretaker—this way, you can save yourself from severely low blood sugar levels
• Get in touch with a dietitian/physician to plan a well-balanced diet and follow the meal plan diligently
• Learn how various exercises can affect your blood sugar levels
• Reduce stress levels as much as possible

 
Besides these, it is always better when friends and family members are aware of what must be done in times of need. For this, keep them informed about the symptoms of high/low blood sugar levels.
 
Conclusion
 
When left unnoticed or untreated, diabetic coma can result in permanent brain damage and death. During times when the blood sugar levels don’t rise beyond 70 mg/dL even after treatment, it is better to call your healthcare provider. Precaution is always better than cure. So, note down early signs of changing sugar levels and take necessary steps to bring them under control. Eat meals regularly, take medications as per doctor recommendations, know what to do once the symptoms start, and doubly care for yourself when ill to avoid any dangerous consequences of the disease.

​Alcohol, in general, is harmful for health and it’s a universal truth. But, what kind of impact it has on blood sugar levels is a very big question mark that needs careful deliberation. These days, most individuals are social or occasional drinkers. Having diabetes doesn’t make a tremendous difference in such cases—this is mainly because drinking is a rarity with such people. But, for those who consume alcoholic beverages regularly, once diagnosed with the disease, it is commonly seen that diabetics reduce their intake by more than 50% compared to other adults. Why so and what’s the advantage of restricting its intake on blood sugar levels?
 
Question Yourself
 
The American Diabetes Association (ADA) recommends that you ask the three below-mentioned questions to yourself:
 

• Do I have a good control over diabetes?
• Am I aware of how alcohol can affect my blood sugar levels and myself?
• Is my healthcare professional ok with me consuming alcohol?

 
Internal Changes that Result After Alcohol Consumption
 
It is a well-known fact that alcoholic beverages have no nutritional value but only add empty calories to the body that can significantly increase the waistline. Overweight/obesity is a grave risk factor for diabetes. But, what’s not so well-known is the fact that these beverages can also be overloaded with sugar. A pint of the drink contains up to 5-6 tbsp of sugar which is the ultimatum given by the World Health Organization (WHO) for a day’s consumption of sugar. Overconsumption of alcohol not only increase glucose levels but also can result in alcohol-related diabetes.
 
The liver keeps producing glucose which is sent to the bloodstream. In this way, the chances of a low sugar level are minimized. But consuming alcohol rattles out the whole process—the breaking down of alcohol in the liver results in the formation of substances which block the glucose production. Due to this, the blood glucose levels fall considerably increasing the risk of hypoglycemia. This problem is common in occasional drinkers who suffer from fatigue and light-headedness. In regular drinkers, the entire process of glucose production, the hormones that regulate it, and effectiveness of insulin are affected resulting in higher blood glucose levels.
 
A single drink might not have a debilitating effect on the overall sugar levels but anything more than that can raise blood sugar levels, especially beverages such as beers, wines, and sherries. The levels rise and in some time, they drop steadily (this often occurs while sleeping) resulting in hypoglycemia.
 
Is It a Safe Bet to Drink in Small Quantities?
 
Sometimes, there is a possibility that the alcohol you drink interacts with some medications. Hence, even before starting to think about drinking, it is recommended that you meet with the doctor and ensure that the alcohol doesn’t interfere with any of your medical conditions or the medicines that you consume.
 
Besides affecting insulin levels, diabetics consuming alcohol are at an increased risk of high triglyceride levels, diabetic nerve problems, cardiovascular diseases, and diabetic eye disease. Individuals with diabetes can drink but with a few do’s and don’ts:
 
Do’s

• Drink slowly and drink only with food
• Drink the beverage mixing with water or soda
• Stay hydrated while planning to have a drink
• Test blood sugar levels often as alcohol consumption commonly makes it harder to judge the symptoms of low blood sugar levels

 
Don’ts
 

• Drink beyond one drink in the case of women and two drinks for men as per ADA recommendations
• Avoid sweet wines or sugary mixers
• Rush the drink but have it slowly
• Drink on an empty stomach

 
The Bottomline
 
Though individuals with diabetes needn’t give up on alcohol completely, it is always recommended to minimize alcoholic intake for you own health. It’s no hazard in enjoying a drink or two but do it with proper guidelines and in moderation. Alcoholic intake might be off the limit for some individuals and this can be understood only if you discuss with your healthcare provider. Try to choose the beverage wisely—maybe a light beer, a dry wine instead of a sparkling wine, and the right mixers.
 
Though one glass of wine might not ruin the health immediately, for some individuals, especially those suffering from diabetes-related long-term problems, it is better to avoid alcohol consumption altogether. Occasional consumption of alcoholic beverages doesn’t put individuals at high risks but moderate/regular (more than 2-4 drinks) consumption affects blood sugar levels badly. Even otherwise, these drinks are overloaded with calories intensifying weight gain chances which once again is a risk factor for diabetes.
 
So, just go for the occasional cocktail or wine, follow the tips and tricks to stay fit, and keep blood glucose levels under control eventually.

Once a diabetic, always a diabetic—this has been the presumption of most patients and even the common man. One of the main reasons for this is because not more than 2% of those with type 2 diabetes (T2D) enter spontaneous remission. When the numbers are not so encouraging, the clinical paradigm still remains that T2D is non-reversible. Maintaining a standardized blood glucose level and adhering strictly to sugar-free and starch-free diets is the current recommendation. Such practices are helpful in maintaining normal glycemic levels but don’t aid in curbing T2D advancement nor promote its remission.
 
There have been a couple of long-term studies and researches that have focused primarily on diet management and lifestyle changes to put diabetes into remission. One of those prominent studies is the DiRECT study (Diabetes Remission Clinical Trial) which clearly shows that weight loss is a very effective way to halt diabetes progression and stalk its effects. The study also showed that following a low-calorie or a very-low calorie diet (LCD or VLCD) is a sure shot way to lose weight efficiently and also sustain the lost weight in the long run by following certain eating habits and dietary interventions.
 
LCD Interventions Offer Beneficial Diabetes Remission Effects
 
Before going into any of the details, let’s start by understanding what is meant by a low calorie diet. An LCD is nothing but consuming between 800 and 1200 calories per day. It is a short-term approach to weight management which should not be followed as a lifestyle change forever. During this tenure, the individual following the LCD is given meal replacements such as shakes and soups, or very small portions of the normal foods that we eat everyday.
 
The diet is usually followed for around 12 weeks after which normal food is reintroduced slowly in small proportions until the normal routine is reached. Such a plan seems easy and doable but practically, following it diligently needs much will power and not all individuals can pursue one. It is always better to consult your doctor and get a green signal for the LCD before venturing into one. If approved, once again it is smart to get the advice of a dietitian/nutritionist to plan the LCD according to your body type, requirements, and health conditions.
 
Recommendations by ADA and EASD for LCD
 
The DiRECT study result showed that almost 50% participants entered diabetes remission and almost a third of them maintained the remission state after 24 months. The effect of remission was directly proportional to their ability to sustain weight loss. Impressed with such results, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have suggested the use of low-calorie diets for patients suffering from type 2 diabetes for achieving remission and diabetes control.
 
Not all individuals can enter diabetes remission and there are a couple of factors that must be fulfilled for being eligible for it. For instance, the individual should maintain HbA1c levels below 6.5 for at least six months continuously and should not be using medications to control diabetes. Until now, the standard care of treatment has not focused mainly on reversal which makes us wonder whether this type of treatment is the best one.
 
But of late, we have a number of studies repetitively emphasizing on the success of LCDs, VLCDs, and carbohydrate restriction (LC). But, most of these have shown that remission is possible for short-term (for 2-5 years) beyond which we do not have clear results on sustaining the remission successfully. The DiRECT study is still in process to understand whether or not long-term remission could be successful and we hope that the picture becomes clearer after this. Still, presently our hope is that LCDs and VLCDs do offer a remedy for diabetes and with sustained weight management efforts and we can keep diabetes under remission—there have been individuals who have maintained the remission for more than 10-15 years.
 
Knowing More about LCDs
 
When we have been eating a specific number of calories until now, suddenly reducing the intake by more than 50% or more has a greater impact on the body. For instance, there are a couple of side effects due to a low-calorie diet including headache, constipation, and dizziness. Continuing an LCD might sometimes lead some people into hypos and hence, keeping tab on blood glucose levels regularly and changing medications might become necessary.
 
Before starting to follow any diet plan, it is better to speak to your doctor and understand whether or not the diet plan satisfies all the nutrient requirements, take glucose tests often, and get in touch with a dietitian to get a custom-made diet plan. Such a plan not only helps people lose weight, which in turn helps manage diabetes, but also assists in maintaining normalized HbA1c levels and blood glucose levels.
 
Conclusion
 
Until now, individuals involved in the DiRECT study and those administered with LCD by ADA and EASD do think that the LCD meal plan is really hard to follow and keep up with, needs ample motivation, and the meal replacements might be quite expensive to many. A total-diet replacement offers better results for T2D remission for a couple of years.
 
We are at a threshold where diabetes could become the greatest health threat if we don’t exert much effort to curb its rise. Given a choice, many individuals would surely opt for reversal and hence, educating people about the availability of diabetes remission is necessary. When reputed organizations such as the ADA and the EASD advise individuals to follow an LCD for diabetes remission and control, what’s the use of CGM, accu-chek, precision nutrition, and other stuff that complicate things without providing the necessary solution? Let’s stick to the basics—a well-balanced diet plan, lifestyle modifications, good sleep, reduced stress, and a daily dose of meditation/yoga to keep diabetes under control.

​Obesity is a concerning issue globally and its impact is even more on diabetes. Statistics show that almost 85% of individuals with type 2 diabetes(T2D) are either overweight or obese. Doctors and healthcare professionals are well-aware of the debilitating effect of obesity in enhancing the risk of diabetes but the same awareness is required among individuals as well.
 
Beta cells in the pancreas lose their ability to make insulin when there is excess fat accumulation around the pancreas. Such fat accumulation affects the production and use of insulin by the body increasing the risk of T2D by 20 times. We are naturally inclined to quote lack of willpower as a primary reason for obese/overweight people to not lose weight but the reasons are much more cruel and come with an ulterior motive.
 
Have you ever thought why pasta, ice creams, candies, and other junk products have more publicity and advertisements than our healthy millets, whole grains, and pulses? Corporate profit is the driving factor behind the obesity epidemic, companies have a 500 billion dollar sales annually in selling fatty, sugary, and salty foods that are addictive and have taken ultimate control of our food habits.
 
It’s high time we realize that it was not until a couple of decades back that obesity has became a concern, the number of diabetes cases have increased, and the consumption of high-fructose corn syrup went up by 1000%. Almost 20-70% less expensive than regular sugar, corn sugar was the standard replacement in the beverage industry, breads, yogurt, ketchup, and more.
 
With the steady rise in the consumption of processed meats, carbohydrates, and soft drinks in the 20th century, the number of diabetics has also increased from 50 million to 400 million in just a few decades. Statistics project a 150% increase in cases by 2050. So, where do you think the problem lies? All these information and data prove without doubt that the food we eat and the lifestyle we adapt play a huge role in diabetes and obesity risk.
 
Reputed health organizations believe that we would become an obesogenic society in not less than ten years. It’s high time we address this obesity issue, deal with the concerns, tackle the junk addiction, and get out of this mess to evade metabolic disorders including diabetes that occur as its side effect.
 
Important Causes of Diabetes
 
Weight gain and obesity are the most important risk factors of type 2 diabetes. So, if the patient is overweight/obese, it is indispensable that the individual focuses on losing weight. By doing this, blood glucose levels are normalized. But we cannot stop with this. It is necessary to address the root cause of diabetes, insulin resistance, and correct this problem to bring about diabetes reversal. For more details about achieving diabetes reversal and to understand the four key steps involved in the process, please visit the website www.firsteatright.com.
 
Even a 5% weight loss improves pancreatic beta-cells function and sensitivity of liver and skeletal muscles to insulin. Further weight loss takes care of the adipose tissue disturbances. There are studies providing better results with reduced diabetes risk when participants pursued an intensive lifestyle intervention compared to consuming medications such as metformin.
 
Tackling Weight Loss
 
Physical activity is an absolute necessity for weight loss but doesn’t exist as the primary concern here. Focusing more on dietary changes is of foremost importance for successful initial weight loss. To maintain this weight loss, it is advisable to enrol in a weight management program. To lose weight or maintain the lost weight, get in touch with reputed dietitians/nutritionists who provide weekly guidance, monitor dietary behavior, and regular exercise schedules. The nutritionist/dietitian gives expert guidance recommending a low-calorie-diet or a very low-calorie diet depending on the individual’s body condition and requirement. With continuous monitoring, adequate sleep, practice of yoga/meditation, individuals are surely bound to lose weight and become fitter.
 
Conclusion
 
According to studies, the more obese an individual, the lesser number of gene variants required to increase their risk of diabetes as these people are already under the physiological impact of obesity and insulin resistance. Diet, exercise, and behavioral strategies must be enforced to achieve desirable weight loss which is easier said than done. But, losing weight has emotional and physical advantages—considerable weight loss reduces HBA1C levels, balances blood glucose levels, sometimes helps people discontinue medication, and even puts diabetes into remission.
Reduction of waist line means less abdominal fat deposit and hence, there is minimal adipose tissue deposit around the pancreas and liver thereby minimizing the risk of insulin resistance. 

​Wouldn’t it be a dream-come-true if a diabetic becomes a non-diabetic, at least for some specific period of time? That’s what the DiRECT trial is all about. The phenomenon where individuals with type 2 diabetes become non-diabetics is called ‘diabetes remission.’ In diabetes remission, most individuals become free from medications and enjoy normal blood glucose levels. Let’s look into the details of this trial to get a clearer picture about diabetes remission.
 
DiRECT Trial
 
An open-ended, controlled trial that had participants from primary care practices all over UK, DiRECT trial included only those who suffered from type 2 diabetes for less than 6 years. The primary focus of this trial was to understand whether or not a structured, intensive, weight-management program was an effective treatment method for type 2 diabetes.
 
The interventions used included withdrawing any use of antidiabetes and antihypertensive drugs, replacing the diet completely (an 825-853 kcal/day formula diet for around 12-20 weeks), reintroducing foods in a stepped manner (2-8 weeks), and providing support for sustaining the weight loss.
 
The results at the end of the 12-month period showed that almost 50% of the participants achieved remission freeing themselves from diabetes and stopping antidiabetes drugs. Almost a third of the participants sustained remission at 24 months. The extent of remission was purely based on the extent to which the participants sustained weight loss.
 
Though not a ‘panacea’ of treatment, this trial provides a new dimension to approaching type 2 diabetes treatment. It motivates individuals to make diet modifications and lifestyle changes right from an early stage of diagnosis. The trial aims to help patients free themselves from the limitations placed by diabetes on their daily living and reduce the risk of diabetes-related complications.
 
Besides weight loss, DiRECT helped participants improve several conditions including psoriasis, allergies, and symptoms of irritable bowel syndrome.
 
NHS-sponsored Low-calorie Programs
 
The positive results of the DiRECT trial motivated NHS to provide free access to a low-calorie-diet program for 5000 people across England. The participants here were provided with a 3-month total-diet replacement products that included shakes and soups. All normal meals were completely replaced with a 900-calorie/day replacement foods for up to 12 weeks. During this period, they were motivated to increase their exercise levels alongside support provided for the same. Once weight loss was achieved, solid foods were reintroduced periodically and weight-loss maintenance guidance was done.
 
The DiRECT trial is still in an ongoing phase and the participants would be monitored for a 7-year period totally to understand how individuals are able to maintain weight loss and remission.
 
A Word of Caution
Never try doing such low calorie diets on your own and it is never recommended to go into this mode as a quick fix for weight loss and diabetes correction. All the participants in the DiRECT trial as well as the NHS-funded low-calorie-diets were guided by expert healthcare professionals right through the program. There were a number of participants who found this experience challenging—a word of caution here, this type of weight loss and remission is not for all. Get in touch with a dietitian/nutritionist, seek medical support and then decide to go on a weight-loss program (if needed) to achieve diabetes remission.
 
The DiRECT team is testing yet another trial called RETUNE where normal-weight people with diabetes can achieve remission. Dietitians play an integral role in all these trials following up on all the three important phases—total diet replacement, food reintroduction, and weight loss management. The team is yet to figure out the benefits of diabetes remission in protecting individuals against diabetes-related complications in the later stages of life.
 
Conclusion
 
The DiRECT trial and the NHS-funded program clearly confirm that weight loss and diet modifications are crucial for controlling and putting diabetes into remission. There have been individuals who have been in remission for more than 15 years with diet changes, physical activities, and lifestyle modifications. When this is clearly evident, what’s the need for minute-by-minute monitoring of blood glucose levels, going around with CGM, or having an accu-chek handy unless the situation demands? Let’s simplify the course of action and reap beneficial results with straightforward plans and executions. Never pay heed to humongous promises that showcase stuff in a mammoth way unnecessarily.

​How would you feel if someone monitors your activities 24*7 all through the day? Intruding? Irritating? Eerie? That’s how many feel toward Continuous Glucose Monitoring (CGM) too. CGM automatically tracks blood glucose/sugar levels all through the day and night giving off an alarm when the glucose levels are too high or low. Besides this, it is possible to enter the meal details, exercise duration, and medications taken. All these data can be downloaded to the computer/smartphone and in some models, erratic changes are instantly sent to the partner, parent, or doctor’s device alerting for immediate attention.
 
Such possibilities are of course a boon in today’s world, but for “who” is the very big question mark here. Reputed diabetes associations, health organizations, and medical institutes are repeatedly conveying the message that CGM isn’t for everyone. But, neither do individuals pay heed to this nor do some health apps or companies abide by this. In this present world, diabetes reversal has become a mantra for all and people are ready to go to any level to control diabetes. Taking advantage of such situations, we have multiple companies trying to allure individuals with new-technology devices and measurement possibilities, one of which is CGM.
 
CGM takes a blood glucose reading every 5-15 minutes but they can never become a substitute for measuring blood sugar levels with a glucose meter. Using a CGM isn’t the solution to tackle Type 2 Diabetes (T2D)—even top-class diabetes organizations stand by this, suggesting its use mostly for patients with:

• Type 1 Diabetes
• An insulin pump/intensive insulin therapy
• Very low (hypoglycemia) or high (hyperglycemia) blood sugar levels
• Erratic high or low blood sugar levels
• Gestational Diabetes

 
It is purely up to the doctor to recommend the use of CGM to improve quality of life of the patient. Are some organizations trying to manipulate the individual here by coming up with diet plans, lifestyle modifications, and exercise schedules based on CGM-related data? They even offer accucheck devices to keep a tab on sugar levels frequently. But, on the other hand, the use of CGM is permitted only with a physician’s prescription. Moreover, it is expensive compared to glucose meters which doesn’t make it affordable to all and insurance coverages aren’t available for this most times. Sometimes, CGM needs ample practise and training to use it in the correct way.
 
Research Findings
 
Irrespective of whether or not an individual with T2D takes insulin medications, there aren’t much research evidence scientifically expressing the advantages of using CGM for T2D compared to Type 1 Diabetes (T1D) patients. Even in those T2D patients with hypoglycemia, the use of CGM hasn’t shown any concrete advantage in decreasing the risk of hypoglycemia.
Yet another long-term study which focused on HBA1C levels showed no significant difference in quality of life or improved A1C levels between individuals using CGM and self-monitoring over a 6-month period.
 
 
Using CGM is Like Allying with the Downside
 
CGM is unnecessary for individuals unless advised by the doctor. It is not only a waste of resources and expenses but has the potential to disrupt the quality of life of the individual using it:
Alarm Anomaly: The ring of the alarm in case of abnormally high glucose levels is a blessing in disguise but the same becomes annoying when it rings incessantly due to maintained higher sugar levels for a couple of hours. It can be turned off but not remembering to turn it on can become a problem during some emergency situation.
 
Allergy Attack: As the device has to be worn continuously, some people face allergy-related problems with the CGM sensor adhesive.
 
Adds More Stress: Knowledge might be power but the same can be troubling when there is too much data at hand. Availability of glucose levels every 10 minutes forces many individuals to have a look at them, in turn increasing their stress and anxiety levels when the numbers aren’t right. Are you going to run to the doctor requesting for a dose change when the sugar levels rise slightly? Will you change the dinner menu just because the CGM data is not stable? All these are necessary for T1D patients but seem irrelevant for T2D individuals who need to focus on long-term goals and work toward it. Never go for too much diabetes-related information else it will affect your mental health badly.
 
Conclusion
 
A device chosen to ease health issues and regulate better body health shouldn’t become the root cause for mental stress, anxiety, and increased BP levels in due course. Relying upon the doctor for monitoring blood glucose levels regularly, following the tips and tricks suggested by the nutritionist/dietitian for lifestyle modifications and weight loss (if needed), getting enough sleep, and avoiding as much stress as possible are more than sufficient when the individual has T2D without any complications mentioned above.
 
The necessity for CGM in T2D patients who don’t take insulin is minimal and there is ongoing research on the benefits of CGM for T2D patients. Until we have conclusive evidence, it is advised strongly not to use such technological devices that complicate rather than complying with your needs. Rather, choose simple but result-oriented steps to achieve diabetes reversal.

​Diabetes control thrives mainly on restricting dietary intake, exercising regularly, and getting into an active lifestyle. Every food consumed contains different nutrients and belongs to some definite food group. We must make wise food choices to stay healthy and keep diabetes under control. One of the foremost recommendations for this include minimizing the intake of carbohydrate-rich foods while including more of vegetables and legumes that have minimal carb content.
 
Glycemic Index (GI)
 
Glycemic index is a value that’s present only in foods having carbohydrates. For instance, foods such as meat, oils, and fats don’t have a GI value but can still affect the blood glucose levels in some other way.
 
Glycemic Index is nothing but the rate at which different foods increase the blood glucose levels in the body. GI numbers rank various carbohydrate-containing foods depending on the speed at which our sugar levels increase and decrease. Foods are segregated as low, medium, and high GI foods. High GI foods are those which are absorbed and digested rapidly while low GI foods take ample time to be absorbed and digested. High GI foods are recommended for consumption after a session of intense exercise training only.
 
A numerical score between 1 and 100 is assigned to foods based on their ability to affect glucose levels with pure glucose given a score of 100. Highly processed foods generally have high GI numbers while foods with abundant fibre content take up lower GI scores.
 
Connecting the Dots Between GI and Diabetes
 
People with diabetes are always asked to stick to a rigid diet plan avoiding sugary items, many fruits in particular, and processed foods. Also, medical physicians, dietitians, and nutritionists recommend diabetics to choose foods with low GI to have good control over blood sugar levels. It might not only help mitigate spike in sugar levels in the body but can also help in weight loss, yet another way in which diabetes can be managed.
 
Various factors such as processing (removing the bran and germ increases GI), physical form, ripeness of produce, fibre content, and fat content of different foods play a prominent role in determining the GI value.
 
The American Diabetes Association has tabulated the GI values of various foods under the name “International Table of Glycemic Index and Glycemic Load Values.” For instance, foods such as barley, quinoa, pasta, oatmeal, most veggies, walnuts, sunflower seeds, mushrooms, apples, and skim meal have low GI. Foods such as baked potatoes, french fries, candies, white-flour pasta, white basmati rice, sugary beverages, and white bread have high GI.
 
In fact, the ADA in the year 2011 published “Standards of Medical Care in Diabetes” where it states that:
 
“Monitoring carbohydrate intake, whether by carbohydrate counting, exchanges, or experience-based estimation, remains a key strategy in achieving glycemic control. For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.”
 
Glycemic Response
 
Glycemic response to any food is the effect of the food on blood sugar levels after consuming it. Consuming any food results in spike in blood glucose and insulin levels soon after eating but the levels drop to fasting levels in course of time. The spike difference is vastly seen in case of foods rich in carbohydrates. The glycemic response after a meal depends on the type of food consumed with the carbohydrates. For instance, combining a low GI food with a high GI food alters the blood sugar levels in a controlled way.
 
To measure the glycemic response after consuming different foods, it is necessary to measure the blood sugar levels every time. The underlying question is whether or not pricking the skin for blood or even CGM is necessary. The answer is a strict no.
 
Firstly, it is only carbs that have a GI value and when a low-carb diet is recommended for individuals with diabetes, there is not the slightest need to measure and monitor glycemic response on a day-in-day-out basis. Secondly, we have standard GI values for different foods and it is good enough to avoid eating high GI foods to maintain blood sugar levels. Obviously high GI foods would generate an undesirable glycemic response which doesn’t seem right. Thirdly, we have ample research data showing that a low GI diet works as an effective tool to reduce the risk of lifestyle diseases. Many of these studies show that altering the glycemic response of any diet could not be used as the only strategy for lifestyle changes but only as a part of the overall tool for a well-balanced diet plan.
 
Summary
 
Making use of the GI value is a valuable means to compare the carbohydrate content of various foods. Many companies might come up with various propagandas about time-to-time measure of glycemic response. Choosing low/medium GI foods is the smart approach to control blood sugar levels and when we have done this correctly, the response would automatically be controlled and stay under desired values.
 
The ADA suggests that the total amount of carbohydrates in any food rather than its GI has a stronger impact on the body’s blood sugar levels—this brings us to another important point which is portion control. Pick the right foods in the right proportions to eat nutrient-rich meals and stay healthy. For this, getting in touch with a nutritionist/dietitian is critical as we can plan a wholesome diet that takes care of GI values but still fulfils the various nutrient requirements of the body without compromising on any food group.

Our body breaks down carbohydrates into glucose for providing energy for the day’s activities. Once this process is done, the pancreas perform their job of secreting insulin which helps cells to absorb glucose. One fact is clear from this—the carbs that we consume raise blood glucose levels in the body and hence, the type and quantity of carbs consumed play a pivotal role in increasing/decreasing sugar levels.
 
Too high glucose levels, also known as hyperglycemia, might be due to overindulgence in carbs, the inability of the body to produce enough insulin to process the carbs, or even due to the ineffective reaction of the cells to the insulin released. Sometimes, there are individuals who suffer from hypoglycemia or low blood glucose levels which might be because of insufficient carbohydrates consumption or due to medication imbalances.
 
Why Choose a Low-Carb Diet for Diabetes?
 
Now that we have some idea about carbohydrates and their role in elevating glucose levels, it is evident that designing a diet plan playing around carb numbers is helpful in controlling diabetes. It’s  true that carbohydrate processing is not much effective in individuals with diabetes. Studies also show that low carbs are highly effective against managing diabetes. Cutting down carb consumption helps in stabilizing blood glucose levels and also reduces the chances of diabetes-related risk factors such as weight gain and heart disease. These are potent reasons for choosing a low-carb diet, isn’t it?
 
Customize Carbohydrate Intakes
 
Very high or very low intake of carbs is dangerous to our body. So, what is the right number? This is the most tricky part as there is no specific number like our BP levels or diabetes range here. The right carbohydrate level varies for each person based on quite a few important factors such as age, sex, physical activity performed, and body size. Besides this, the blood sugar levels and the medications consumed impact the much needed carbs intake for your body.
 
Firstly, carbs doesn’t equate to sugars. There are three types of carbs namely sugar, starches, and fiber which together comprise the ‘total carbohydrates’ that’s seen commonly on food labels. It’s up to the individual to choose the right carbs wisely and add better health to our body. For instance, going for a very low carb diet without the proper guidance of a nutritionist/dietitian might result in vitamin or mineral deficiencies. Choose foods that are abundant in fiber and nutrients while being low in unhealthy sugars and sodium.
 
Fiber: The meal should consist of these mostly. Unprocessed, whole, and non-starchy vegetables such as cauliflower, broccoli, kale, tomatoes, cucumber, and lettuce are abundant in fiber and nutrients. Ensure that they take up at least half the food plate. The American Academy of Nutrition and Dietetics recommends that men and women consume 25 and 38 g of fiber respectively.
 
Starches: Being a diabetic, there is not the slightest need to give up on fruits which belong to starchy carbohydrates. Fruits including all types of berries, apples, cantaloupes, melons, and guavas are a great choice as they are packed with fiber. No fruit is off the limit for diabetes but the catch here is to consume them in a controlled way spacing the intake throughout the day. Starchy veggies like potatoes, plantains, yam, pumpkin, and green peas must be taken in moderation. Include a small portion of pulses such as chickpeas, kidney beans, lentils, and black beans along with the brown rice, whole wheat foods, whole grain pasta, and oatmeals. All these together must take up a quarter of the food plate. Nuts are high in fats but full of nutrients like fiber, unsaturated fats, folate, and vitamins. Never fail to make a handful of nuts a daily part of the meal plan.
 
Sugars: It is always better to reduce the consumption of sugary foods that are rich in processed carbs and sugars. Intake of sugar-added beverages including soda, sweet juices, sweetened teas, refined flour including white rice and bread, sugary cereals, and bakery snacks such as pastries, candies, chips, and cookies must be minimal. 
 
A low-carb diet should include around 130 grams or lesses of carbohydrates. Hence, rather than playing around with the food choices on your own, it is better to take guidance from a medical authority to plan them. Pick and choose some foods, slowly reduce the carb intake and analyze the changes in blood glucose levels for the foods consumed.
 
Dairy is a part of the daily intake but the recommendation of milk and other dairy products purely depends on the individual and his/her needs. Sometimes, dietitians/nutritionists recommend non-fat dairy to control weight gain in people with diabetes but mostly, a small portion of dairy is needed for fulfilling the required calcium and protein needs. Lactose-intolerant people going for dairy alternatives should ensure that the products are calcium-fortified and unsweetened. Lean meats and seafood rich in omega-3 fatty acids such as prawns, salmon, and sardines are the right picks. Being good sources of proteins, these seafoods satisfy hunger hormones and also keep cholesterol under control.
 
The Bottom Line
 
A low-carb diet consists more of veggies with proteins and healthy fats in moderation. The glycemic index and value of foods present in this diet is low. When carb-rich foods are replaced with low-carb foods and healthy fats, the chances of controlling diabetes are higher. But, diet alone doesn’t bring significant changes. Combining physical activity, sleeping well, and reducing stress are key elements of keeping diabetes under control.
 
But never stop eating carbohydrates completely as they are the powerhouses of energy. Failing to consume enough carbs cab bring about deleterious effects on the body including dehydration, dizziness, fatigue, and other disorders. Plan the food choices and quantity of food intake with your medical team and keep updating them on the progress regularly to reap good results. 

Every individual is designed uniquely and there is no denial regarding that. Our basic necessities remain the same but our metabolic rates, functionality, energy levels, and nutrition requirements differ person-to-person. Eating healthy food, including ample green leafy veggies, and having enough fruits, nuts, and pulses is mandatory for all. The catch here is the quantity of foods and the type of foods. Eating a balanced diet remains a thumb rule for staying healthy but one must understand that there is no one-size-fits-all approach when it comes to planning diets and maintaining an active lifestyle.
 
Diabetes & Diet
 
It is a well-known fact that 80% of individuals entering diabetes or pre-diabetes stage are obese/overweight, and that’s the primary reason why doctors recommend losing weight for correcting HbA1c levels and maintaining blood glucose measures. Weight loss can be achieved through various methods and for diabetes especially, medical experts recommend following a low-calorie diet plan. Dietitians and nutritionists execute maximum caution and plan a well-balanced diet plan suiting the individual’s weight loss needs and BMI values. Combining this with regular exercise, enough sleep, meditation, yoga, and reducing stress is the best way to enter diabetes remission. Read more about diabetes remission and ways to do it by visiting www.firsteatright.com.
 
Though a straightforward approach, there are health companies that publicize about making use of precision nutrition, CGM, and more to achieve diabetes remission. Let’s understand what is precision nutrition and whether or not it’s needed for controlling diabetes.
 
Precision Nutrition
 
Precision nutrition is nothing but coming up with targeted and effective diet interventions depending on the individual’s characteristics and body type. The person’s gender, age, lifestyle, race, weight, and other details are considered to derive a specific meal plan. The concept of precision nutrition gives the much-needed answer to ‘What can I eat to be healthy?’
 
It is indeed a novel field that’s got ample scope as it includes a customized approach involving genetics, microbiome, health history, and personal habits. But the primary question here is whether using precision nutrition presently in clinical settings is effective, and above all, necessary.
 
A study from 2015 analysed the diet intake of 800 participants based on the data from gut microbiota and an algorithm pertaining to their dietary intake was formed. Using this algorithm, a personal diet plan was done and post-meal sugar levels significantly reduced in all. But the same team wondered whether the same outputs could be achieved in those individuals following a different dietary and lifestyle approach.
 
Another paper in The American Journal of Clinical Nutrition dwelled into two types of continuous glucose monitors. All the participants were fitted with these monitors and the expectation was that both the devices provided similar blood sugar results.
 
Sadly, both the monitors did not synchronize in their readings. For instance, one monitor reported that consuming bagel was better while the other one reported consumption of cereal as a preferred approach for the same individual. Such hazy results question the precision of precision nutrition and even makes one wonder whether mankind would be able to offer dietary choices based on this ideology. There is no denial that we might one day exist at the threshold where precision nutrition might be effective in dealing with health-related situation but now is not the time. Moreover, diabetes is a problem that could be combated using simple and effective measures that correct the basic problems relating to insulin resistance and blood glucose management.
 
Current technology and study results don’t offer positive outcomes for using precision nutrition. We need ample research and studies to completely understand this approach and gauge whether it might  prove to be beneficial.
 
Choose to Use Precision Nutrition before it Proves to be Right?
 
There have been a couple of studies and trials that show the potent benefits of precision nutrition in lowering blood glucose levels. But most of them are on a small scale, include a small number of participants, and there aren’t a considerable number of researches showing consistent results in this area.
 
We need hi-tech technologies, expensive tools, and the results might vary depending on the type of tests used in various trials. Such difficulties and inconsistencies could affect the choices for personal recommendations.
 
Until we have rock-solid proof for positive results, we cannot bring about dietary changes such as these as a replacement for our conventional intervention practices.
 
Some key areas that clearly raise doubts regarding the effectiveness of precision nutrition include:
 

• Personalized dietary choices must be in tune with the general nutrition ideas such as consuming more fruits and vegetable while minimizing the use of sugars and sodium.
• Such customized solutions can’t be afforded by all which brings disparities among the population. Rather, bringing in population-based changes that make the entire food environment healthier and sustainable is the need of the hour
• Findings from various studies have never been replicated in another study group which raises sure doubts about the uniformity of the results
• Various studies have observed tremendous glycemic variabilities and there is an ocean of data that must be collected. Both of these can have a huge impact on the results and the suggestions applicable for the patients

 
Precision Nutrition is Not as Precise as it Seems
 
Despite technological advancements, an individual’s food choices depend greatly on a number of factors such as environmental factors, education, income level, lifestyle practices, and social support system. In reality, such factors impose a greater influence on what a person chooses to eat much more than genetic or biochemical measures. Going by this, focusing primary on what’s feasible for individuals must be the greatest priority.
 
Never judge a book by its cover—just because we can measure the macro and micro nutrients of each food, it doesn’t mean that we keep giving little tweaks to the diet on a day-to-day basis. Even worse, just because we measure the CGM and keep getting values, we needn’t make diet modifications every couple of hours to the food that we eat.
 
Some health companies boast about building 87+ parameters to build the nutrition database and coming up with individualized food plans. What’s the need for so much fuss when it all boil down to simply eating healthy food, including veggies and fruits, minimizing carbs, and keeping fats and proteins in balanced proportion? The foods remain the same, it’s the portion sizes and the types of foods chosen which impose greatest influence on our body’s health. For this, our weight, BMI value, health history, food preferences, and environment background are more than enough to plan the perfect diet plan for diabetes remission or control. Pocketing more bucks for diet plans based on precision nutrition, forcing individuals to use CGM, and even recruiting a big-sized team for tracking one person’s health is a gimmick.
 
There is over high expectations from precision nutrition which is still in the infancy stages of development and research. In the future, after thorough research and deeper investigation, it might be possible for combining public health concerns with precision nutrition strategies. The field does seem promising but the biggest question is its potency to suit for all—the need for mammoth data collection and hi-tech use of latest equipment makes it a very expensive procedure. Hence, the government must also execute caution before investing too much in research over precision nutrition at the stake of public health.  

Disrupted Metabolism & Diabetes
 
Overindulgence in sugar intake, sedentary lifestyle, and heredity are some of the well-known causes of diabetes in layman terms. If we analyse the root causes of this disease scientifically, it is none other than disrupted metabolism. Often, we’ve heard the mention of the word ‘Metabolism’ in context with weight loss, but this term has a greater effect on the overall functioning of the human body.
 
Metabolism is the process by which the body uses the food consumed to make energy which could be used immediately or stored for use later in the liver, body fat, and muscles. Disruption of this process leads to a metabolism disorder which could be due to the following reasons:

• Malfunctioning of the organs such as the pancreas, thyroid, or liver leads to metabolic disorder.
• Genetics might also be the reason sometimes
• Rarely, some disorders don’t have a root cause and the perfect example is type 1 diabetes, an autoimmune disorder affecting some people for reasons unknown.

 
While controlling genes or probing into something that doesn’t have a root cause is impractical, we can always do our best regarding factors that could be corrected. For instance, diabetes is a metabolic disorder which is primarily due to factors such as stress, lack of physical activity, improper diet, and insufficient sleep. There are numerous research papers published worldwide expressing that changes in our diet and lifestyle are the main contributors of diabetes. Addressing the root cause is the need of the hour and that means siding with metabolic correction.
 
Type 2 Diabetes results due to decreased sensitivity to insulin receptors which again is due to disrupted metabolic functioning in converting glucose to energy. Improving the body’s biochemical-physiological mechanism naturally leads to better control in diabetes levels. We can achieve metabolic correction by making diet modifications, ensuring sufficient hydration, and introducing dietary supplements.

Reputed healthcare organizations and scientific papers keep repeating the four mantras for treating chronic metabolic diseases and these include:
 1. Diet Changes
2. Physical Activity
3. Adress Stress
4. Enough Sleep

When the potential for improving body healthy with simple tweaks is possible, why complicate stuff and panic individuals by encroaching them with fanciful terminologies such as artificial Intelligence or IoT for modifying participants’ lifestyle or monitoring day-to-day-changes?
Attaching a piece of device to monitor a person’s health stats 24*7, all 365 days of the year might sound attractive but what’s the need for an external attachment in our body? It is admissible in the case of type 1 diabetes which might suddenly show erratic behavior, but using AI for type 2 diabetes (T2D) is unnecessary.
 
There are some companies and health setups which promise changes in diet, exercise, and even meditation patterns depending on the AI and IoT-based data input. But, isn’t it funny for the doctor to keep analysing every single line of data for the slightest changes in eating pattern or sleep pattern and introduce newer changes? So, is the doctor going to suggest a 3-minute extra sleep or 5 more rounds of sit ups depending on the AI-based information? Even if he/she provides such modifications, isn’t it human nature to fret over such changes, succumb to more stress, and go back to the anxiety cycle that existed before starting the diabetes reversal/diabetes control journey?
 
Let’s not complicate something that’s simple and straightforward. Don’t be lured by high-tech words or give into a treatment just because it’s different and high-end. What we want is long-lasting solution to treat diabetes or put it into remission and, this is feasible with proper guidance from nutritionists/dietitians who stick with the methods suggested above.
 
Stop believing in those who try to brainwash minds with solutions based on AI-based data collection, minute-to-minute monitoring of blood glucose levels, IoT-based correction of diabetes, and more. All these are simply gimmicks to encash from individuals or to enforce false ideologies regarding diabetes. Start believing in yourself and your ability to control daily diet, exercise regularly, do yoga or meditation, and sleep soundly—contact a dietitian/nutritionist for simple modifications in food habits and practical exercise suggestions to go back to a healthy life with controlled diabetes or diabetes remission.
 

Have you ever wondered where the sweetness in your chewing-gum and toothpaste comes from? No – for once, it’s not our favorite punching bag, sugar; rather it’s an artificial sweetener called xylitol. Also known as ‘wood sugar’, xylitol is a sugar alcohol (a type of sugar substitute) that is used to sweeten sugar-free candies, chewing gums, dental products like toothpastes and baking goods.
 
A lot of us may not know this, but about 38% of urban Indians consume artificial sweeteners every month. This is not hard to believe, considering that low-calorie or zero-calorie sweeteners are commonly used to replace sugar in many processed foods, especially diet soda and other soft drinks. Besides, those of us seeking to curb our sugar intake are invariably drawn towards foods marketed as ‘low sugar’, ‘no sugar’ or ‘sugar free’. Who doesn't know that the easiest way to enjoy sweet tea without using sugar is to pop in a packet of stevia or aspartame? Some practitioners also advise the use of artificial sweeteners in a bid to combat obesity and diabetes.
 
Not surprisingly, the production of sweeteners like xylitol has increased manifold in the past 10 to 20 years. As responsible consumers, it is incumbent upon us to ascertain whether or not these artificial sweeteners are as healthy as they appear to be. Although they were previously considered safe, recent evidence to the contrary has made them targets of scrutiny and opposition.
 
 Sugar Alcohols
 
The term ‘sugar alcohol’ is a misnomer, meaning a very misleading name, because these compounds are neither sugars nor alcohols. They are type of carbohydrates mostly derived from nature but also synthetically produced in certain situations. Sugar alcohols are commonly extracted from oats, birch , berries, sugarcane bagasse or corn husk. One can find them in many low-calorie  or sugar-free foods like snack bars, ice creams, frostings, cakes, cookies and jams. Sugar alcohols are not included in the category of ‘added sugars’, which means that manufacturers are free to brand products containing sugar alcohols as ‘sugar free’. It is, however, easy to spot them on food labels (which, by the way, none of us read) as they always end with the suffix ‘-ol’, like lactitol, sorbitol, xylitol etc.
 
Sugar alcohols differ from other groups of non-nutritive sweeteners (NNS) in the sense that they are metabolized in the body. However, these are only partially absorbed by the small intestine. Consequently, the amount of calories per gram obtained from sugar alcohols is up to 75% lesser than that of table sugar, while the intensity of sweetness is about the same. Additionally, they are broken down slowly during digestion, preventing sudden spikes in blood glucose and insulin levels.
 
As stated earlier, until recently, sugar alcohols were generally regarded as safe, as they were mostly ‘natural’. In fact, the only objections against them were that they could potentially cause gastrointestinal problems. The slow digestion process allows gut bacteria more time to feed on carbohydrates, resulting in fermentation and excessive gas formation. This draws water into the large intestine, causing loose stools, diarrhea and abdominal pain.
 
A serious eye-opener came with the  2023 study that linked high levels of erythritol in the blood to cardiac arrest, stroke and early death. Now, a new report published in the European Heart Journal shows similar findings related to xylitol.
 
 Xylitol found to increase risk of MACE
 
The Cleveland Clinic conducted a survey on 3,000 people to analyze the  effect of xylitol on our body. The subjects were asked to consume separately a xylitol-sweetened drink and another containing sugar. Their blood samples were then studied to compare the after-effects.
 
It was observed that the platelet reactivity of a person was significantly enhanced immediately after downing the drink containing xylitol. A similar change was not seen in case of the sugar sweetened product.
 
Platelets are tiny cells in our body that prevent blood loss by helping to clot blood at the points of injury. There seems to be some sort of a receptor on our platelets that instructs them to be more susceptible to clotting when it senses xylitol. The blood samples taken showed an abnormal increase in the efficiency of platelets. Xylitol had caused them to cluster together, leading to thrombosis (the fancy term for blood clots). These seemingly harmless blood clots could then travel up the blood vessels leading to the heart muscles, triggering a heart attack. Or they could travel to the arteries and veins in the brain, thereby obstructing blood flow and causing a stroke.
 
It was concluded that large amounts of xylitol consumption heightened the risk of a major adverse cardiac event (MACE) within a period of three years. In view of such reports, the World Health Organization (WHO) has cautioned consumers against the use of artificial sweeteners for weight loss. These findings remind us of the need for more extensive research on the long term toxicity of low-calorie sweeteners that are increasingly becoming a part of our diets. At all times, it is best to consult a certified healthcare  professional or dietitian before making any significant food choices.
 
 If not artificial sweeteners, then what?
 
First sugar was bad. Now artificial sweeteners are bad too. So what do we do? There is no point in turning to jaggery, maple syrup, agave or honey; they’re just as bad as refined sugar when it comes to calories. Cutting down completely on everything sweet certainly seems like an ideal option, but it may not be realistic enough for many of us to implement. If you have an overactive sweet tooth the absolutely must be indulged sometimes, then fresh or frozen fruits make an excellent choice. Unlike refined sugar, which gives nothing but empty calories, fruits are loaded with benefits – fiber and vitamins, while also containing some amount of natural sugar. Combining a handful of  cut mangoes or strawberries with yogurt, infusing water with slices of sweet lime or freezing cubes of pineapple for a chilled treat doesn’t sound like a bad option!