Diabetes is one of the leading causes of death and there are more than 400 million people suffering from diabetes worldwide most of them belonging to developing countries. The global diabetes rates have risen from 4.7% in 1980 to 8.5% in 2014 and according to WHO estimates, diabetes was the seventh leading cause of death in 2016. Diabetes is hereditary and those with family members suffering from diabetes are at an increased risk of the illness but there is no hard and fast rule that says that people with a family history of diabetes are sure victims to the disease. Its only that their risk is one step higher than the rest of the population. But with regular physical activity, normal body weight and diet schedules it is always possible to prevent or delay the onset of type 2 diabetes mellitus (T2DM) which is more frequent in overweight young adults and aged populations. T2DM has the ability to leave the patient with increased risk of heart attacks, strokes, kidney failure, foot ulcers and diabetic retinopathy. There have also been statistical data showing that one of every four diabetes patients suffer from depression which in turn could increase the risk of T2DM-related complications. Once a patient’s blood sugar levels are higher than normal levels the patients are started on diabetes medications. Medicines are dispensed to reduce the risk of even those individuals who are in a pre-diabetes stage where regular physical activity, exercise and an active lifestyle would definitely help in controlling sugar levels greatly and this is due to the flexibility and low-cost nature of drugs. Once you start your body on anti-diabetes meds it’s going to remain likewise for a lifetime.
Metformin is presently the first choice of medication along with diet and lifestyle changes for treating type 2 diabetes as it helps in lowering fasting plasma insulin concentrations, total and LDL cholesterol and free fatty acids. Metformin is used as a preventive medicine for middle-aged obese individuals. Still, we are unable to do anything about the long-term complications of the drug. With the ever-increasing diabetes rates, it is necessary to come with solutions that are safe, cost effective and above all, provide excellent glycemic control. When we talk about all these qualities in a solution what’s better than alternate medicines and natural therapy? Even the World Health Organization Expert Committee on diabetes has recommended the research of traditional herbs for coming up with solutions for treating diabetes mellitus, the most common of them include Allium sativum (garlic), Ginseng species, Momordica charantia (bitter melon), Trigonella foenum-graecum (fenugreek) and A. cepa (onion). Garlic is an ingredient that has ruled our kitchens for thousands of years being one of the oldest plants cultivated. It also finds itself useful as a therapeutic agent thus occupying a permanent spot in our lives-it contains compounds such as allicin (exhibits hypocholesterolemia), is an antioxidant, hypotensive, anticoagulant and also has antithrombotic effects. It’s been seen that consuming 10 g of raw garlic per day along two meals for six weeks helps in reducing blood glucose and HbA1c levels in patients with diabetes mellitus and we have research also showing that consuming garlic helps in improving blood HDL-cholesterol levels. There are also studies showing the beneficial effects of garlic in reducing blood pressure levels, risk of cardiovascular disease and colorectal cancer. Garlic is surely a hot-selling cake in the research world as its being studied more and more with respect to blood sugar management. A bunch of randomized control trial (RCT) were conducted in the last decades to see its effect on blood sugar management. While we don’t have a thorough analysis the study here is a meta-analysis of all the available RCTs to understand the functioning and efficiency of garlic supplements/extracts in controlling T2DM and its impact on total cholesterol, triglyceride, high density lipoprotein (HDL) and low-density lipoprotein (LDL).
A Meta-analysis on the Effect of Garlic Extracts
The meta-analysis was reported using PRISMA guidelines and online searches were conducted in PubMed, EMBASE, Cochrane Library and China National Knowledge Internet (CNKI). Search terms were included after careful research and finally, eligible studies were included based on different criteria and duration of garlic administration. The search yielded 226 abstracts of which 216 of them were rejected as they did not meet study criteria. Finally, only 10 articles were involved in the study and this included 430 patients in the garlic group and 338 T2DM patients in the control group. Fasting blood glucose (FBG) levels were between 6.2 mmol/L to 12.2 mmol/L. Five therapies included monotherapy of garlic for T2DM that was diagnosed newly and four trials included therapy that was a combination of garlic and an oral hypoglycemic drug for T2DM that was already diagnosed. Garlic doses were between 0.5g to 1.5 g daily administered for anywhere between 2 and 24 weeks. Outcomes were measured from 1 to 24 weeks for FBG, 1-4 weeks for plasma fructosamine and 12-24 weeks for HbA1c.
Effect on FBG: FBG reports were mentioned in 7 trials. Depending on the duration of garlic administration patients were put into any one of the five subgroups: short-term (≤8 weeks) and medium-term (>8 weeks) periods. In short-term subgroup, meta-analysis results in 1-2 weeks, 3-4 weeks and 6-8 weeks showed that garlic consumption showed evident reduction in FBG levels compared to controls. In the medium-term subgroup too, garlic helped in reducing FBG levels at 12 and 24 weeks compared to control group.
Effect on plasma fructosamine: This was reported in two trials. Meta-analysis results in 1-2 weeks and 3-4 weeks showed significant reduction in plasma fructosamine levels in the garlic group compared to the control group.
Effect on HbA1c: 2 trials reported on HbA1c. Meta-analysis in 12 and 24 weeks showed that garlic reduced HbA1c levels in garlic group compared to control group.
Effect on Other Indexes: Postprandial blood glucose levels also reduced significantly after garlic consumption compared from 2 weeks to 12 weeks. C-peptide was higher in garlic group.
Effect on blood liquids: Cholesterol, triglyceride, HDL and LDL were compared in 1-2 weeks, 3-4 weeks and 12 weeks. Triglyceride levels reduced in 3-4 weeks of garlic consumption and in 12 weeks for total cholesterol and LDL levels. There was an increase in HDL levels in 12 weeks too after garlic consumption.
Side effects were almost negligible with three trials reporting five cases of heartburn and one trial reporting two cases of indigestion in the garlic group and one case in the control group. This study clearly shows that garlic consumption has a positive effect in controlling total cholesterol and LDL levels and also in raising HDL levels in around 12 weeks.
Dispensing Garlic Supplements along with Diabetes Medications
60 patients diagnosed with diabetes mellitus were split into two groups of 30 each. Those in group 1 (GR1) were given garlic tablets at a dose of 300 mg thrice a day and patient in group 2 (GR2) were given a placebo. Patients in both the groups received metformin tablets at a dosage of 500 mg twice daily apart from the garlic or placebo medication. All the patients were asked to come with 12 hours fasting for lipid profile and fasting blood sugar analysis at week 0, week 12 and week 24 respectively. All other medications were not allowed during the study period and the patients were constantly motivated and monitored for their compliance with healthy lifestyle measures such as regular exercise and diet. Results showed that there was a significant reduction in fasting blood glucose levels in group 1 compared to group 2. Mean age of participants in GR1 was 40 years and in GR2 it was 35 years. One patient in GR1 reported heart burn and consequently left the study, two patients in GR1 and three patients in GR2 were also dropped as they did not come back regularly for monitoring their blood glucose levels, 17 patients in GR1 and 18 patients in GR2 were diagnosed with concurrent dyslipidemia.
GR1 showed significantly lesser mean glucose levels and fasting blood glucose levels too. Mean total cholesterol, LDL and triglycerides reduced greatly in GR1 compared to GR2. There was a significant increase in HDL after 12 weeks of study.
Effect of Garlic Pills on Pregnant Women
Nowadays, pregnant women with diabetes (gestational diabetes) is a common occurrence. Borderline gestational diabetes mellitus (BGDM) is associated with higher chances of caesarian deliveries, preterm birth, macrosomia, preeclampsia, neonatal hypoglycemia and stillbirth. Effective treatment methods for gestational diabetes mellitus (GDM) or BGDM include diet, physical activity and maintaining a normal body weight. Owing to inappropriate eating habits and sedentary behavior we do see a steady increase in the number of pregnant women with gestational diabetes and according to WHO reports, more than three-quarters of the population in developing countries use herbal medicines as their numero uno choice and one-third of diabetes-affected individuals use effective alternative medicines such as garlic.
After imposing multiple selection criteria, the final sample size was down to 44 participants each of whom were assigned to the intervention (garlic) or control (placebo) group. The average age of these women was 29.6 years, most were housewives, 56% women were pregnant with their first baby and 90% had no history of abortion. Every participant received 1 pill (either garlic or placebo pill) every day after meals for 8 weeks. While the garlic pill contained 400 mg of dry garlic powder the placebo pills contained starch but giving the same appearance as the garlic pill. Results showed that:
Effect of Garlic Supplement in the Management of Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Control Trials: https://foodandnutritionresearch.net/index.php/fnr/article/view/1230/4530
Garlic Supplementation with Standard Antidiabetic Agent Provides better Diabetic Control in Type 2 Diabetes Patients: https://www.researchgate.net/publication/51682026_Garlic_Allium_sativum_supplementation_with_standard_antidiabetic_agent_provides_better_diabetic_control_in_type_2_diabetes_patients
Effects of Garlic Pill on Blood Sugar Glucose Level in Borderline Gestational Diabetes Mellitus: http://ircmj.com/en/articles/60675.html
Patent: Wearable Spectroscopic Sensor to Measure Food Consumption Based on Interaction between Light & the Human Body
The world is witnessing an obesity epidemic which is mainly related to our consumption of foods. Worldwide obesity rates have almost tripled since 1975 with almost 39% adults aged 18 years and over suffering from overweight issues and 13% suffering from obesity as of 2016. Obesity in children is also rapidly on the rise with almost 1 in every 5th child suffering from overweight issues and almost 50% of these children live in Asia. The irony here is that we have reached this threshold despite obesity being a preventable disease. Its not like we are all blind to the obesity epidemic and there are actions taken from all sides-the government, people and physicians to control it but the problem only seems to be growing more and more. Preventing and treating obesity remains on top of the list for a better future generation who would otherwise suffer from chronic illnesses and debilitating diseases right from their young age. We need innovative and feasible ways to help people moderate their consumption of healthy food, manage energy balance (calories consume vs calories expelled) and lose weight in a healthy and sustainable manner.
The current trend is junk food consumption which has attained new heights with latest innovations. These foods are nothing but high in simple sugars and saturated fats with negligible nutrition. A donut might seem small but the calorie content in it is large. When we munch one during our snack time, we tend to ignore it in our daily total calorie consumption. Its not good enough to believe that dieting in our own style or relying on our so-called willpower will help us overcome consumption of junk or ensure portion control. Weight management and weight loss depend on proper nutrition intake and management of calorie intake else. Else, if we continue at this present pace the day is not far off when every other person living is either overweight/obese faced with life-threatening health problems and well-being issues.
Our eyes deceive us and our hearts feel for us and we make mistakes calculating our calorie intakes or in figuring out where we are going wrong in trying to lose weight despite our dieting regimens. The invention patented here exactly addresses this problem thereby helping any individual monitor and control his/her intake of foods and nutrients. It also stands tall in the sense that it helps a person reduce his/her consumption of junk foods and their intake quantity too.
The invention is based on the concept of a wearable device that measure’s a person’s food consumption based on the interaction between light energy and the person’s body. This wearable device can be a finger ring, smart watch, wrist band, armlet, cuff, sleeve or wrist bracelet. The device comprises of the following:
On a comparative note, the technical challenges of identifying consumption of selected types of foods, ingredients and nutrients is much more than the challenges of identifying which types are healthy or unhealthy. The selected ingredient or nutrient is estimated indirectly using a database that links common types and amounts of foods with common types and amounts of ingredients or nutrients. The device does not rely on estimates from a database but does require more complex ingredient-specific or nutrient-specific sensors. There are many individuals who consume ultra-processed foods whose main ingredient is sugars. In these foods, the sugar content is mostly hidden or disguised in the form of labeling it as ‘cane sugar’ or ‘100% natural’ but in reality, they are not good for the body and the device here isn’t fooled by these fancy labelling terms and the ingredients.
The device here also caters to the needs of people allergic to certain foods, excludes those deemed as ‘unhealthy’ by the user’s physician and also has the potential to analyze food composition to identify one or more types of foods whose consumption is prohibited or discouraged for religious, moral and cultural beliefs. The volume or quantity of food consumed is estimated by analyzing one or more pictures of the food. The volume might be calculated by using a physical or fiduciary marker such as a plate, utensil, or an item of a known size. Otherwise, the food scale might be used to measure the weight of food prior to consumption and the weight of unconsumed food remaining after consumption to estimate weight of food consumed based on difference in pre vs post consumption measurements. The device monitoring food consumption might comprise of a wearable sensor that is configured to be worn on a patient’s wrist, hand, finger or arm and the sensor corrects data that is used to detect probable eating events without requiring action by the person in association with a probable eating event apart from the act of eating; a smart food utensil, probe or dish that collects data which is used to analyze the chemical composition of food that the person eats; a data analysis component where this component analyses data collected by the food utensil, probe or dish to estimate the types and amounts of foods, ingredients, nutrients and calories that are consumed by the person and, this component also analyzes the data collected by the sensor and food utensil for getting a clear account of the individual’s total food consumption.
This spectroscopic device is not the go-to device for relying 100% on all your required good nutrition and weight management but it does aid the individual in encouraging good nutrition, weight management, energy balance and overall health. The patent was published on March 17th, 2016 and for detailed description of the patent please refer:
United States Patent & Trademark Office: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=%22wearable+spectroscopic+sensor%22&s2=%22measure+food+consumption%22&OS=
World Intellectual Property Organization: https://patentscope.wipo.int/search/en/detail.jsf?docId=US160392400&_cid=P22-JY8GAI-73892-1
We have complicated lives by simplifying lifestyles. Walking has become only an exercise and shopping has become mostly Internet-based. Curtain blinds, cooling sheets and air-conditioners invoke the pleasures of staying inside, advancements help us get things delivered to the doorstep-right from groceries and meals to beauty services and yoga classes. There exists not much need to meet Mr. Sunshine and say hello to the glowing sun that helps in producing vitamin D endogenously in the skin upon exposure to its rays. Besides, we can count the meagre number of foods that are excellent sources of this vitamin. All these make most of us deficient in vitamin D which opens the doors to multiple complications and problems in life. This is no exaggeration, but we see teens and young adults having negligible amounts of vitamin D in their body thereby suffering from joint problems and lack of energy.
The effect of vitamin D in bone health and calcium homeostasis is widely known- hypovitaminosis D is a major contributor of osteoporosis owing to failure of calcium absorption, secondary hyperparathyroidism and increased bone resorption. But now, we see vitamin D being increasingly linked to other health conditions such as obesity, cardiovascular disease, type 2 diabetes, cognitive effects, hypertension, myocardial infarction, cardiovascular death and total mortality rates. But is vitamin D linked with endothelial function?
Vitamin D and Endothelial Function
The endothelium once thought of simply having no functionality beyond allowing water and electrolytes permeability has become one of the most important endocrine organs. Vascular endothelial cells are found throughout the circulatory system responsible for fluid filtration in the glomeruli of the kidneys, homeostasis and neutrophil recruitment. Endothelial cell response is involved in various disease processes such as atherosclerosis, hypertension, pulmonary hypertension, sepsis and inflammatory syndrome. All these diseases are linked to endothelial injury, dysfunction and activation.
Endothelial dysfunction is an early event in cardiovascular disease that has now become simpler to diagnose. Earlier, an invasive procedure was used where artery catheterization was necessary to assess endothelial dependent vasodilation. It is characterized by a shift in the actions of the endothelium toward reduced vasodilation, a proinflammatory state and prothrombic properties. Normally, the endothelium helps in regulating blood clotting, immune response, controls volume of fluids and electrolytes that pass from blood to the tissues and produces dilation or constriction of blood vessels. But with the presence of endothelial dysfunction the ability to perform one or more of these functions is affected. It’s also been believed that endothelial dysfunction plays a prominent role in laying the foundation for atherosclerosis, vascular leakage, infectious diseases and stroke and is mainly caused due to diabetes, metabolic syndrome, hypertension, smoking and sedentariness.
Vitamin D has been linked with cardioprotective properties especially through its action on the endothelium. But the mechanism in which vitamin D might affect atherosclerotic process has not been completely understood. It might be due to increased nitric oxide (NO) production, reduced oxidative stress, decreased interleukin 6 (IL-6) expression or vascular cell adhesion molecules (VCAM) and intracellular adhesion molecule (ICAM). Vascular expression of NF-κB was more in individuals with vitamin D deficiency and endothelial expression of IL-6 was also higher in vitamin D deficient patients. Still, the effects of vitamin D supplement consumption on endothelial function is not yet clear. A meta-analysis on the impact of vitamin D supplement on endothelial function is discussed below:
Meta-analysis of Vitamin D Supplement on Endothelial Function
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were used and multiple databases include PUBMED were searched. While the search came up with 213 citations finally only 12 studies were eligible for inclusion in the meta-analysis. Each of the studies had between 34 and 114 participants, two studies had only female participants and other studies had between 14% and 84.1% women, mean age of participants was between 29 and 67 years and each of the studies included various vitamin D supplement doses.
Study findings suggest that vitamin D supplementation might improve vascular function. A double-blind placebo study on 34 patients showed that a single dose of 100000 IU vitamin D2 supplement versus placebo increased flow-mediated dilation (FMD) in 8 weeks of follow-up. Another study examining the effects of vitamin D3 (3,00,000 IU) supplements for 3 months in vitamin D-deficient individuals also showed an increase in FMD levels. Another study that administered two different levels of vitamin D (1,00,000 IU and 2,00,000 IU) and placebo in 61 patients at 8 and 16 weeks showed no difference in FMD for the vitamin D group. Researchers have discovered vitamin D receptors in several cell types including vascular smooth muscle cells, endothelial cells and cardiac myocytes. Vitamin D synthesis by endothelial cells helps in regulating impact of inflammatory cytokines on the vasculature and studies do support the fact that vitamin D supplementation can have a positive effect on FMD and reduce risk of cardiovascular disease.
Vitamin D’s Impact on Endothelial Dysfunction on Patients with Chronic Kidney Disease
Chronic kidney disease (CKD) affects almost 10-15% of population impairing their health and economy of both, the patient and the society. The tricky point here is that CKD doesn’t result in death due to renal failure but most of the times due to cardiovascular events. Many CKD patients usually suffer from vascular disease and endothelial dysfunction from early stages which is followed up by marked vascular stiffening and arterial calcification. There have also been concerns that vitamin D compounds might cause deterioration of renal function but we don’t have much studies on vitamin D’s effect on CKD patients.
A meta-analysis was conducted as per PRISMA guidelines and randomized control trials were included. Patients with CKD given vitamin D supplements were the intervention group and the placebo group included those who received no treatment. Outcomes were restricted to flow mediated vasodilation (FMD). FMD is mainly a measure of the capacity of the endothelial cells to produce nitric oxide (NO); it is a measure of function and not structure which makes it an early sign of vascular disease and a predictor of cardiovascular risk. Database search using specific search criteria resulted in a total of 1744 articles and after further screening only 14 articles were selected for full review of which 4 studies met full inclusion criteria. Each of the studies had between 24 and 120 participants and study duration was between 12 and 16 weeks. All the patients were between 44 and 65 years of age and in stage 3 or 4 of CKD.
A total of five studies with 305 participants were evaluated and none of them showed difference in FMD measures at baseline between the intervention and the placebo group. Chitalia et al showed positive effects of dispensing vitamin D (3,00,000 IU) given as two doses at the beginning and at 8 weeks during a 16-week trial; Kendrick et al compared cholecalciferol 2000 IU with calcitriol 0.5 μg daily for a period of 6 months but could not detect any changes in FMD.
Favorable effects were seen in both, fixed and random model studies, supporting the fact that vitamin D is advantageous on endothelial function. Also, maximum benefits were seen on younger patients as they were mostly in the earlier stages of the disease.
Effect of Vitamin D on Endothelial Function: Placebo-controlled Trial
We do very well know that overweight and obesity are serious risk factors for development of hypertension and CVD apart from vitamin D deficiency. Also, excess fat increases the risk of vitamin D deficiency and is also associated with endothelial dysfunction, a precursor to hypertension. So, a randomized placebo-controlled trial was conducted to determine the effect of vitamin D supplementation on endothelial function on obese/overweight individuals with vitamin D deficiency.
Though a total of 489 individuals were initially screened only 93 of them were finally included-46 received ergocalciferol and 47 received placebo. But finally only 84 participants (43 assigned to ergocalciferol and 41 assigned to placebo) completed the study whose mean age was 37 years and mean BMI was 33.9. Results showed that:
The various studies and meta-analysis show that the evidences supporting the effect of vitamin D on endothelial function is conflicting. Yet we are sure that a majority of the population suffers from vitamin D deficiency which needs to be addressed. Hence, make way for some sunshine in your life to make your day brighter and your health better.
The Impact of Vitamin D Supplement Intake on Vascular Endothelial Function: A Systematic Review & Meta-analysis of Randomized Control Trials: https://foodandnutritionresearch.net/index.php/fnr/article/view/1145/4405
Treating Endothelial Dysfunction with vitamin D in Chronic Kidney Disease: A Meta-analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156877/
Effect of Vitamin D on Endothelial Function: https://academic.oup.com/ajh/article/30/2/124/2525927
Carbohydrates are one of the macronutrients along with proteins and fats required for survival of the human population. But this poor thing has been rolled and tossed by people who adore it or sometimes loathe it to the extreme that they cut off its intake to the maximum extent possible. One main reason for hating the macronutrient and succumbing to fad diets that boast of low-carb foods is weight loss. If you think deeply, carbohydrate is the only macronutrient that does not have an established minimum requirement. Even our ancestors who hunted and gathered food primarily depended on animal and plant foods including fruits, honey and starchy foods that were rich in carbohydrates. While we have so much to boast about this macronutrient why do many people in our society keep despising it? Carbohydrates are the only ones that directly increase our blood glucose levels but we have studies showing that the total amount of these nutrients as a percentage of dietary energy is less critical than the type of this nutrient consumed for risk of any chronic disease including diabetes. For example, potatoes, sugar-sweetened beverages and refined grains are usually associated with increased risk of diseases while legumes, fruits and minimally processed grains are associated with reduced risk of the disease.
The food’s effect on our body’s blood sugar levels can be indicated with two measures: glycemic index (GI)and glycemic load (GL). GI value helps in comparing foods depending on the standardized amount of carbohydrates (values are assigned depending on how slowly or quickly the particular food will raise blood sugar levels) while GL allows to get a better prediction of how much the food will raise a person’s blood glucose level after eating it and it also takes into account the amount of carbohydrates present in a portion of food. GL is much more helpful in predicting glycemic response than the amount of carbohydrates, proteins and fats in foods. We have studies showing that higher GI or total GL is a serious risk for type 2 diabetes in both men and women. Type 2 diabetes incidence rates have multiplied greatly in recent decades promoting it as an epidemic. This chronic disease spares none and even small kids are affected by juvenile diabetes (type 1 diabetes). While type 2 diabetes is genetic this does not imply that all those who have a family history of diabetes are sure preys to the disease and those who don’t have a family history will never acquire it! Ultimately, the risk revolves around your lifestyle practices which play prime roles in determining your course of health including risk of diabetes. Such predominance among the worldwide population necessitates the need for immediate prevention and management techniques and current research studies are focusing on interventions involving dietary modifications as diet has always been the go-to solution for diabetes management.
There are even millions of those in prediabetes stage where their blood sugar levels are higher than normal but not high enough to be termed as a diabetic. While some of them resort to taking medications even during this stage most physicians suggest lifestyle changes as the first measure towards controlling blood sugar levels. For diabetes patients too, medications are simply not enough to keep glucose levels under control. They need to bring in appropriate diet changes and ensure to practice some physical activity, preferably walking, to keep diabetes under control. Reducing postprandial blood glucose response (PBGR) is needed to achieve glycemic control and this is the first aim of any dietary intervention to avoid risks of complications from hyperglycemia.
Eating Foods for the Cause of Favor Instead of Flavor
Its not new to hear advices strewn across the Internet, neighbors giving free consults or family members assuming a doctor’s position recommending diabetes patients to eat more of certain foods, avoid certain foods and restrict some others. Sweets are unanimously voted against eating; wheat is always promoted and fruits have been bounced and kicked around as they have contradictory results. Mangoes, sapodillas, grapes and jackfruits have always been resisted by diabetic patients as they have the tendency to increase blood sugar levels spontaneously but there are some who avoid taking any of the fruits fearing altered sugar levels. This is an entirely different stream that needs proper channelizing but one thing is clear-fruits are not enemies of diabetes. Controlling portion sizes and incorporating fruits in accordance to your daily diet routine is the key. Generally, dietary interventions are primarily focused on foods with a low glycemic index (GI) and we have epidemiological studies linking low GI or low GI diets with reduced risk of developing diabetes. Whole grains, vegetables and fruits are generally included as a part of the diet for people with diabetes as these have a low GI index and another food that stands out above the rest of these include pulses that not only contain low GI but also have other benefits such as high amounts of dietary fiber, low amount of fat, high levels of micronutrients, proteins and easily digestible carbohydrates.
Pulses, the dried seeds of legumes (beans, lentils, chickpeas etc.) have always been promoted as an indispensable part of a healthy meal as it is touted to improve nutrition and health outcomes. We do have numerous studies showing the benefits of pulses consumption in reducing type 2 diabetes (T2D) risk. A review of 41 controlled clinical trials showed that pulses were associated with improvements in markers of long-term glycemic control irrespective of whether or not it was consumed alongside a low-GI, high-fiber diet or regular diet. Other studies too have always focused on the effects of pulses with a high-GI, starchy control food which surely does help in reducing PBGR but the magnitude and consistency of their effects and also the exact portion required to lower PBGR remain unknown. Also, we do know that all pulses do have a certain amount of PBGR lowering quality but again, we do not know if the effect is consistent across all. Lentils have shown promising effects in great many studies and the study discussed below assessed the PBGR-lowering effect of cooked lentils in a mixed meal that included high-GI foods. Here, half of the carbohydrates from high-GI foods were replaced with cooked lentils in a mixed meal. The study was formulated with the main aim of comparing PBGR and relative glycemic response (RGR) following meals consumed with starch-rich foods alone and in combination with cooked lentils too.
Letting Lentils Tell You About their Fellowship with Diabetes
Th study included healthy participants aged between 18 and 40 years with a BMI of 20-30 who were split into two separate groups. Both the groups attended a total of five 3-h morning study visits separated by a 3- to 7- d washout period. The treatment included providing 50 g available carbohydrates (AC) based on glycemic carbohydrates (total starch and free sugars) and proximate analysis. The analysis was performed on raw foods to avoid conflicting results due to moisture content present after cooking but analyses done before and after cooking showed that there was no difference in total starch, free sugar and resistant starch. Treatment options were of two types-it either included consuming white rice/white potato alone or consuming white rice/white potato in combination with 3 different varieties of lentils (large green, small green and split red lentils). The foods were prepared according to designated protocols with the necessary amount of water. The meals were consumed within 10 minutes of preparation with 250 mL of bottled water with the exception of cooked potato where the participants were allowed to drink as much water as they wished.
The participants arrived for every study after a 10-12-h overnight fast, avoiding alcohol consumption, performance of unusual physical activity, OTC medications or consuming pulses for 24 h prior to study and consumed the same meal (of their choice) for dinner the previous evening. Height, weight, blood pressure and waist circumference were measured at each study. Blood samples were collected at fasting and 15, 30, 45, 60, 90 and 120 min after the first bite of the study treatment using which glucose levels were analyzed.
26 participants were assigned to rice group and 25 participants to potato group. But finally, only 24 participants remained in each group due to impaired glucose tolerance results in the eliminated participants. Average age of participants in both groups was around 27 years and BMI reading was around 24. 11 participants completed the rice and potato treatment. Results showed that:
Effect of Replacing Meals in Obese/Overweight Subjects
Low GI foods have also been promoted for weight loss but studies are not conclusive. The following study attempts at altering both GI and amount of carbohydrates in well-defined mixed meals to find out glucose and insulin response in overweight/obese participants over the course of a 12-h day. Participants aged between 18 and 70 years who were devoid of chronic diseases, had a BMI reading of 25-35 and fasting serum glucose levels ≤125 mg/dL participated in the study. All participants were assigned to one of the four diets (high GI, high carbohydrate [HGI-HC]; high GI, low carbohydrate [HGI-LC]; low GI, high carbohydrate [LGI-HC]; and low GI, low carbohydrate [LGI-LC]) with at least a 3-day washout period in between diets. For every diet period all of them were fed a standard American diet consisting of 34% fat, 15% protein and 51% carbohydrates for 3 days prior to test days. While breakfast and dinner were consumed at the test center, lunch was provided as a takeout. All of them were given 20 minutes to consume the meal and were requested to finish all the foods provided.
Menu was formulated for four isocaloric diets that differed in GL by manipulating GI based on white bread values and percent energy from carbohydrates. The meal consisted of mixed foods and energy from protein was maintained at 20%. On the fourth day after a 10-h fast blood samples were collected from all the participants just before breakfast and at regular intervals thereafter (at 15, 30, 45, 60, 90, 120, 150 and 210 min) for 12 h. Participants were asked to rate their hunger level between 0 and 100 with 0 defining ‘I am not hungry at all’ and 100 defining ‘I have never been more hungry’. Results of 26 participants (10 males and 16 females) who completed the study showed that:
Carbohydrate Replacement of Rice or Potato with Lentils Reduces the Postprandial Glycemic Response in Healthy Adults in an Acute, Randomized Trial: https://academic.oup.com/jn/article/148/4/535/4965930
Reducing the Glycemic Index or Carbohydrate Content of Mixed Meals Reduces Postprandial Glycemia & Insulinemia Over the Entire Day but Does not Affect Satiety: https://care.diabetesjournals.org/content/35/8/1633
Dietary Carbohydrates: Role of Quality & Quantity in Chronic Disease: https://www.bmj.com/content/361/bmj.k2340
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