The confusion around nutrition, also extends to the management of diabetes mellitus, the metabolic condition that causes high blood sugar.
Because food plays such an important role in managing a disease that has been known to medicine for over two centuries, traditional remedies abound, further clouding the picture.
With World Diabetes Day coming up on Saturday November 14, Better Health asked UAE experts to address a few popular myths concerning diabetes and nutrition.
1. People with Type 2 diabetes never have to take insulin
Truth: In both types of diabetes, insulin is a way to control blood glucose levels. Mehfuza Haffiz, a Senior Clinical Dietitian at Dubai Health Authority (DHA) says the strangest misconception she has encountered in her practice concerns the suitability of insulin for diabetics. She sets the record straight: “Type 2 diabetes is a progressive disease and eventually requires insulin for its management but regular exercise, losing weight, healthy eating habits and oral medications can delay the progression of the disease, and with it, insulin medications.”
In fact, not all diabetics need insulin. Those with type 1 – about five to ten per cent of all cases – require insulin because their pancreas does not make the hormone. But insulin isn’t always prescribed for those with type 2 diabetes, which is the majority of all cases. Speak to your doctor for clarity.
2. I need to go on a diet if I have diabetes
Truth: There’s no such thing as the diabetic diet. In fact, people with diabetes are regularly advised to eat a healthy, balanced diet, much like everyone else – except that they need to be careful what they’re eating doesn’t elevate their blood sugar levels. A good way to measure this is to see where foods rank on the glycaemic index (GI). The metric ranks carbohydrate-containing foods from one to 100 based on how slowly or quickly they are digested, and the rate at which they increase blood glucose levels. Different carbohydrates are digested and absorbed at different rates. In general, Haffiz says, foods with a higher GI will cause a higher rise in your blood sugar, while research shows that low-GI foods can help manage long-term blood glucose (HbA1c) levels in people with Type 2 diabetes.
Use caution, however. Not all low-GI foods (with a rating below 55) are healthy – some brands of chocolate, for example, may have a medium or low GI because their fat content impedes the absorption of carbohydrates.
3. Diabetics can’t eat any sugar
Truth: People with diabetes can still eat sweets, chocolate, or other sugary foods as part of a healthy diet. “Having diabetes doesn’t mean you have to cut sugar out of your diet completely and there’s no problem including them as a treat occasionally,” Haffiz explains. “Too much refined or added sugar is usually accompanied by an unhealthy diet, which can lead to weight gain and obesity,” she says. This makes diabetes management difficult and increases the risk of serious health problems such as heart disease and stroke. “Diabetes or not, we all should be cutting down our free sugar intake.”
4. Diabetics must skip all starchy foods
Truth: This pervasive myth needs to be exploded, says Dr Al-Hamwi. “Diabetic patients can eat healthy, complex carbohydrates,” she says, “Brown rice, sprouted brown rice and breads made from whole grains are healthier and can help balance blood sugar levels. Include these in your daily diet to maintain a healthy lifestyle.”
Haffiz reiterates the advice about portion sizes. “Even though whole grains are healthy, don’t eat unlimited
amounts. A good guide is to eat about three servings of whole grains each day. This works out to about half cup of cooked brown rice, oatmeal or whole wheat pasta,” she says.
5. Fruits are high in sugar, so diabetics should avoid them
Truth: Most low-GI fruits are fine in moderation if you are diabetic, says Dr Hamwi. “Avoid fruit juices, however, because they’re stripped of their naturally occurring fibre – which means they raise blood glucose levels quickly.”
Haffiz agrees, pointing to advice from the American Diabetes Association that any fruit is fine to eat for a person with diabetes. “Fresh or frozen fruits are better than processed fruits straight from a can or jar, such as applesauce and canned fruit, as well as fruit and fruit juices. These can cause a spike in the sugar levels,” she says. “Fruit can also satisfy a sweet tooth without resorting to candy and other foods with low nutritional value.
“Most fruit is high in nutrients and low in fat and sodium, and contains nutrients not found in other foods. Most guidelines recommend that adults and children eat five servings of fruits and vegetables each day. This does not change for people with diabetes.”
6. Keto is the best diet for diabetes
Truth: The popularity of the low-carb, high-fat diet and its dramatic (but unsustainable) impact on body weight has prompted many diabetics and pre-diabetics to consider going keto. However, while a ketogenic diet may help a few some people with type 2 diabetes to keep glucose levels low, following the diet alongside an insulin regimen can lead to a higher risk of developing hypoglycaemia or low blood sugar, Haffiz warns. “As the ketogenic diet involves switching to a different source of energy, it can lead to some adverse effects,” she says.
In addition, Dr Al-Hamwi says the keto diet may be injurious for diabetics because it can put stress on the kidneys.
7. Bitter foods lower your sugar numbers
Truth: Foods such as the bitter melon have been traditional diabetic treatments, but science has yet to confirm the vegetable’s efficacy one way or another. Some studies indicate that such bitter foods lower blood sugar levels by causing more glucose to enter the cells, and then helping the body process it. Bitter melon, in particular, seems to lower blood sugar and A1c levels in people with type 2 diabetes. Yet, other studies show no correlation between the consumption of bitter melon and blood sugar levels. “The ability of a plant to lower blood sugar levels is dependent on the presence of phytochemical constituents can lower blood glucose.
“But plants don’t need to have a bitter taste to contain such active phytochemicals,” Haffiz says. “The notion that bitter-tasting foods have an anti-diabetic effect is just an urban myth.”
As Dr Al-Hamwi says, “The most important thing is to follow a healthy lifestyle and choose healthier food options with a low GI and which are high in fibre. Remember to exercise regularly and quit smoking if you haven’t already.”