Your Health by Dr. Harold Gunatillake (Health writer)

When your doctor reveals that you suffer from ‘adult type of diabetes’ in your middle ages or earlier, he may suggest anti-diabetic medication to take orally to stimulate your pancreas (insulinogogues) to produce more resisting insulin, or to suppress flow of stored glucose from the liver (gluconeogenesis), he may prescribe drugs like metformin, or if you are an early diabetic (pre-diabetic), he may suggest you to go on a strict low glycaemic diet (GI) initially.

It would be difficult at this stage to discipline your lifestyle, and invariably not take the doctor’s advice seriously, knowing the carefree life of most Sri Lankans.

When you decide on an exercise plan to control diabetes, a disciplined diet plan also goes with it simultaneously. It is better to adhere to low GI foods, foods converted to glucose in the gut, and your blood sugar level may remain within the normal ranges, without spiking…

On this plan, white rice and white bread should be avoided for life. White rice is a refined carbohydrate. Researchers from Harvard School of Public Health suggest that its consumption is linked to the risk of developing type 2 diabetes. A tablespoonful of boiled brown rice and a slice of brown bread per day are permissible. One or two potatoes per day is allowed to be eaten due to its high micro-nutrient content, including vitamin C and fibre. ‘Brown food’ being unprocessed is recommended due to its slower digestion and absorption and to its high micro-nutrients and fibre in the bran, as found in brown rice. Round grained white rice (sambas) have high GI of 80 whilst the long grain white rice (Basmati, Dongara), the GI is about 60. The latter is digested and absorbed slower due to its high amylose content Enzyme amylase secreted in the pancreas, converts carbohydrates to maltose and sucrose. The maltose and sucrose are then absorbed into the lining cells of the intestine and further simplified, being converted into glucose.

White rice and diabetes type 2
Studies have shown that the association between white rice consumption and risk of type 2 diabetes has been examined in both Asian and Western populations, but the findings are not entirely consistent across studies.
The substantial difference in baseline rice intake levels between Asians and other populations for whom rice is not a staple food may contribute to the inconsistency of existing results

Pooled data suggest that higher white rice consumption is associated with increased risk of developing type 2 diabetes in comparison with lower intake levels. This association is stronger for Asian (Indians, Sri Lankans, Chinese and Japanese) populations than for Western populations. Overall, there was a dose-response relation between higher intake of white rice and increasing risk of diabetes (ref: BMJ 2012; 344 doi: published 15 March 2012).

There are more studies to show that eating white rice regularly, as is commonly done in many Asian countries, may increase risk for developing type 2 diabetes. Researchers looked at data from four studies: two in Asian countries (China and Japan) and two in Western countries (the U.S. and Australia). All participants were diabetes-free when the studies began.

On average, people from Asian countries ate about four servings of white rice daily. Individuals in Western countries, however, ate less than five servings a week. The study found that the more servings of white rice a person eats per day, the greater their risk for developing type 2 diabetes, the form of diabetes most closely linked to obesity.

According to the new study, diabetes risk rises by about 10 per cent with each increased serving per day of white rice. Spyros Mezitis, MD, agrees that all white starchy foods increase the risk for diabetes when eaten in excess. He is an endocrinologist at Lenox Hill Hospital in New York City.

Anyone at risk for diabetes should focus on reducing the number of calories they eat, losing weight (if they are overweight or obese), and replacing white carbs with whole grain foods. “Always try to eat less and go for the whole grain instead of the white starch,” he says.

Tracy Breen, MD, is the director of diabetes care for North Shore-LIJ Health System in Great Neck, N.Y. She says that what you eat, and how much of it you eat, is only part of the equation. Genes also count when it comes to diabetes risk.
“It is never just one thing,” she says. “It’s what you eat, what you do, and your genes. We can’t change our genes, so it’s important to think about how food plays into our culture.” Some experts, including Connie Diekman, RD, say that the jury is still out on whether white rice really increases diabetes risk. She is the director of university nutrition at Washington University in St. Louis

Pasta
Pasta has a lower Glycemic Index (GI) than rice, and does not cause sugar in the blood to rise quickly due to the benefits of prolonged carbohydrate absorption.

Slow-release carbohydrates/low glycaemic index (GI) foods may have benefits for healthy longevity and physical and cognitive performance, and may play a key role in preventing chronic diseases such as obesity, diabetes, coronary heart disease and certain cancers. (GI measures how rapidly a carbohydrate triggers a rise in blood sugar — the higher the number, the greater the blood sugar response.)

Like rice, pasta is not eaten alone, but with vegetables, fish, legumes and lean cuts of poultry and meat. By combining with these accompaniments you further slowdown the rate of absorption. Most pasta is made from semolina flour unlike bread made from common wheat flour. Semolina is considered a better carbohydrate than wheat flour.

Pasta is not a white food, considered golden or amber because it is made from semolina flour, which is ground from durum wheat. Semolina flour is considered healthier than white wheat flour used to make white bread.
Semolina is a product of wheat milling that is created when the wheat kernels are processed using corrugated cast-iron rollers. During this phase of wheat milling, the bran, germ and endosperm are separated and the endosperm breaks into coarse grains. These coarse grains are called semolina and are used in the production of many food products. Pasta is a good source of B vitamins, iron, and niacin. It is low in sodium and cholesterol free. The endosperm has no fibre as in the bran.

Eating eggs
Much maligned egg is in the forefront today when considered being healthy and for well-being, People with type 2 diabetes may include eggs in their diet as part of a healthy weight-loss eating plan.

The new research, published in the February edition of the British Journal of Nutrition, has revealed eggs are not only a great source of protein for people with type 2 diabetes but that a high protein diet which includes nutrient-dense eggs can actually deliver significant health benefits. The research found that two eggs per day did not adversely affect the cholesterol levels in people with type 2 diabetes but in fact improved levels of HDL-C (‘good cholesterol’) in those people in the egg protein arm of the study.
The British Journal of Nutrition article titled ‘Egg Consumption as part of an energy-restricted high-protein diet stated that eggs improves blood lipid and blood glucose profiles in individuals with type 2-diabetes’.

Soft drinks (Sodas)
Indeed, a study of more than 90,000 women tracked for eight years by researchers at Harvard University in the United States found those who had one or more servings a day of sugar-sweetened soft drink or fruit punch were twice as likely to have developed type 2 diabetes during the study compared with those who rarely had these drinks.

Exercise
Exercise is the best medicine for all chronic disease like for an ailing heart, diabetes, or keeping fit and healthy right through life. Exercise is the best remedy more for slow growing adult type of diabetes than the early onset diabetes.

Both aerobic and strength training on a daily basis can reduce the blood sugar level in the blood without medication. Such control depends how much you exercise, and the time involved whether you could spare such time. Such exercises like walking or swimming, strengthens the heart, lungs, and muscles, and controls the blood pressure and blood sugar. Walking or other moderate-intensity exercise, three to seven days a week, for a total of 150 minutes per week OR jogging or other vigorous exercise, three days a week, for a total of 90 minutes per week, and Weight lifting or other muscle-strengthening resistance exercise (weight machine, etc.) three days a week. Regular exercise cuts the risk of more than 20 illnesses.

The chance of major diseases, including colon cancer, heart disease, diabetes, osteoporosis and stroke are all reduced with weekly exercise, according to the study published in the International Journal of Clinical Practice. Apart from not smoking, being physically active is the most powerful lifestyle choice an individual can make for improved health outcomes, especially those suffering from diabetes.

Initially, when you are diagnosed having diabetes, it is best to start on a walking program, at least half an hour daily, without having special tests. For more active exercises it is best that you have a stress (treadmill) test first if you haven’t been active, or having been diagnosed with heart disease, or any other chronic disease, or unexplained shortness of breath and chest pain.

When you are given the okay for vigorous types of exercise, you may start with a low-impact activity like walking, swimming, or bicycling, gradually increasing weekly to reach the maximum level within your ability. It is said that the best time to exercise is an hour or so after eating, when your blood sugar is likely to be higher. Exercising before meals may give an appetite to eat more and the purpose will be lost and you are bound to put on weight.
To be certain how exercise responds to lowering of blood sugar, you may check your blood sugar levels before and after meals. Exercise seems to prompt your body to use insulin efficiently- if you eat a sensibly-sized meal. Exercise also controls insulin, blood pressure, weight, and well-being.

While regular exercise can help control blood sugars, it can cause your sugar to drop. To help keep your levels in check, your doctor may recommend you test your blood sugar before and after exercise. If exercise makes your blood sugar dip, don’t avoid exercise. Instead, have healthy snacks — like fruit — with you to avoid a serious drop.

Juice, fruit, hard candy, or glucose tablets are all sources of quick sugar that can help if you’re feeling the effects of low blood sugar. Feeling tired, weak, or shaky are tell-tale signs. When your blood sugar drops (hypoglycaemia), your goal should be to get at least 15-20 grams of sugar or carbs. Avoid foods with sugar in combination with fat, like chocolate.

Fat can slow your body’s ability to get the carbs it needs quickly enough. Carry “jelly beans” with you wherever you go, as sugar levels may go down without your knowing and jelly beans would be a lifesaver. In conclusion, go on a low GI diet and a daily exercise program if you desire to keep away from anti-diabetic medication for life.


Exercise And Diet Alone Can Control Type 2 Diabetes
By Dr Harold Gunatillake
When your doctor reveals that you suffer from ‘adult type of diabetes’ in your middle ages or earlier, he may suggest anti-diabetic medication to take orally to stimulate your pancreas (insulinogogues) to produce more resisting insulin, or to suppress flow of stored glucose from the liver (gluconeogenesis), he may prescribe drugs like metformin, or if you are an early diabetic (pre-diabetic), he may suggest you to go on a strict low glycaemic diet (GI) initially. It would be difficult at this stage to discipline your lifestyle, and invariably not take the doctor’s advice seriously, knowing the carefree life of most Sri Lankans. When you decide on an exercise plan to control diabetes, a disciplined diet plan also goes with it simultaneously. It is better to adhere to low GI foods, foods converted to glucose in the gut, and your blood sugar level may remain within the normal ranges, without spiking… On this plan, white rice and white bread should be avoided for life. White rice is a refined carbohydrate. Researchers from Harvard School of Public Health suggest that its consumption is linked to the risk of developing type 2 diabetes. A tablespoonful of boiled brown rice and a slice of brown bread per day are permissible. One or two potatoes per day is allowed to be eaten due to its high micro-nutrient content, including vitamin C and fibre. ‘Brown food’ being unprocessed is recommended due to its slower digestion and absorption and to its high micro-nutrients and fibre in the bran, as found in brown rice. Round grained white rice (sambas) have high GI of 80 whilst the long grain white rice (Basmati, Dongara), the GI is about 60. The latter is digested and absorbed slower due to its high amylose content Enzyme amylase secreted in the pancreas, converts carbohydrates to maltose and sucrose. The maltose and sucrose are then absorbed into the lining cells of the intestine and further simplified, being converted into glucose. White rice and diabetes type 2 Studies have shown that the association between white rice consumption and risk of type 2 diabetes has been examined in both Asian and Western populations, but the findings are not entirely consistent across studies. The substantial difference in baseline rice intake levels between Asians and other populations for whom rice is not a staple food may contribute to the inconsistency of existing results Pooled data suggest that higher white rice consumption is associated with increased risk of developing type 2 diabetes in comparison with lower intake levels. This association is stronger for Asian (Indians, Sri Lankans, Chinese and Japanese) populations than for Western populations. Overall, there was a dose-response relation between higher intake of white rice and increasing risk of diabetes (ref: BMJ 2012; 344 doi: published 15 March 2012). There are more studies to show that eating white rice regularly, as is commonly done in many Asian countries, may increase risk for developing type 2 diabetes. Researchers looked at data from four studies: two in Asian countries (China and Japan) and two in Western countries (the U.S. and Australia). All participants were diabetes-free when the studies began. On average, people from Asian countries ate about four servings of white rice daily. Individuals in Western countries, however, ate less than five servings a week. The study found that the more servings of white rice a person eats per day, the greater their risk for developing type 2 diabetes, the form of diabetes most closely linked to obesity. According to the new study, diabetes risk rises by about 10 per cent with each increased serving per day of white rice. Spyros Mezitis, MD, agrees that all white starchy foods increase the risk for diabetes when eaten in excess. He is an endocrinologist at Lenox Hill Hospital in New York City. Anyone at risk for diabetes should focus on reducing the number of calories they eat, losing weight (if they are overweight or obese), and replacing white carbs with whole grain foods. “Always try to eat less and go for the whole grain instead of the white starch,” he says. Tracy Breen, MD, is the director of diabetes care for North Shore-LIJ Health System in Great Neck, N.Y. She says that what you eat, and how much of it you eat, is only part of the equation. Genes also count when it comes to diabetes risk. “It is never just one thing,” she says. “It’s what you eat, what you do, and your genes. We can’t change our genes, so it’s important to think about how food plays into our culture.” Some experts, including Connie Diekman, RD, say that the jury is still out on whether white rice really increases diabetes risk. She is the director of university nutrition at Washington University in St. Louis Pasta Pasta has a lower Glycemic Index (GI) than rice, and does not cause sugar in the blood to rise quickly due to the benefits of prolonged carbohydrate absorption. Slow-release carbohydrates/low glycaemic index (GI) foods may have benefits for healthy longevity and physical and cognitive performance, and may play a key role in preventing chronic diseases such as obesity, diabetes, coronary heart disease and certain cancers. (GI measures how rapidly a carbohydrate triggers a rise in blood sugar — the higher the number, the greater the blood sugar response.) Like rice, pasta is not eaten alone, but with vegetables, fish, legumes and lean cuts of poultry and meat. By combining with these accompaniments you further slowdown the rate of absorption. Most pasta is made from semolina flour unlike bread made from common wheat flour. Semolina is considered a better carbohydrate than wheat flour. Pasta is not a white food, considered golden or amber because it is made from semolina flour, which is ground from durum wheat. Semolina flour is considered healthier than white wheat flour used to make white bread. Semolina is a product of wheat milling that is created when the wheat kernels are processed using corrugated cast-iron rollers. During this phase of wheat milling, the bran, germ and endosperm are separated and the endosperm breaks into coarse grains. These coarse grains are called semolina and are used in the production of many food products. Pasta is a good source of B vitamins, iron, and niacin. It is low in sodium and cholesterol free. The endosperm has no fibre as in the bran. Eating eggs Much maligned egg is in the forefront today when considered being healthy and for well-being, People with type 2 diabetes may include eggs in their diet as part of a healthy weight-loss eating plan. The new research, published in the February edition of the British Journal of Nutrition, has revealed eggs are not only a great source of protein for people with type 2 diabetes but that a high protein diet which includes nutrient-dense eggs can actually deliver significant health benefits. The research found that two eggs per day did not adversely affect the cholesterol levels in people with type 2 diabetes but in fact improved levels of HDL-C (‘good cholesterol’) in those people in the egg protein arm of the study. The British Journal of Nutrition article titled ‘Egg Consumption as part of an energy-restricted high-protein diet stated that eggs improves blood lipid and blood glucose profiles in individuals with type 2-diabetes’. Soft drinks (Sodas) Indeed, a study of more than 90,000 women tracked for eight years by researchers at Harvard University in the United States found those who had one or more servings a day of sugar-sweetened soft drink or fruit punch were twice as likely to have developed type 2 diabetes during the study compared with those who rarely had these drinks. Exercise Exercise is the best medicine for all chronic disease like for an ailing heart, diabetes, or keeping fit and healthy right through life. Exercise is the best remedy more for slow growing adult type of diabetes than the early onset diabetes. Both aerobic and strength training on a daily basis can reduce the blood sugar level in the blood without medication. Such control depends how much you exercise, and the time involved whether you could spare such time. Such exercises like walking or swimming, strengthens the heart, lungs, and muscles, and controls the blood pressure and blood sugar. Walking or other moderate-intensity exercise, three to seven days a week, for a total of 150 minutes per week OR jogging or other vigorous exercise, three days a week, for a total of 90 minutes per week, and Weight lifting or other muscle-strengthening resistance exercise (weight machine, etc.) three days a week. Regular exercise cuts the risk of more than 20 illnesses. The chance of major diseases, including colon cancer, heart disease, diabetes, osteoporosis and stroke are all reduced with weekly exercise, according to the study published in the International Journal of Clinical Practice. Apart from not smoking, being physically active is the most powerful lifestyle choice an individual can make for improved health outcomes, especially those suffering from diabetes. Initially, when you are diagnosed having diabetes, it is best to start on a walking program, at least half an hour daily, without having special tests. For more active exercises it is best that you have a stress (treadmill) test first if you haven’t been active, or having been diagnosed with heart disease, or any other chronic disease, or unexplained shortness of breath and chest pain. When you are given the okay for vigorous types of exercise, you may start with a low-impact activity like walking, swimming, or bicycling, gradually increasing weekly to reach the maximum level within your ability. It is said that the best time to exercise is an hour or so after eating, when your blood sugar is likely to be higher. Exercising before meals may give an appetite to eat more and the purpose will be lost and you are bound to put on weight. To be certain how exercise responds to lowering of blood sugar, you may check your blood sugar levels before and after meals. Exercise seems to prompt your body to use insulin efficiently- if you eat a sensibly-sized meal. Exercise also controls insulin, blood pressure, weight, and well-being. While regular exercise can help control blood sugars, it can cause your sugar to drop. To help keep your levels in check, your doctor may recommend you test your blood sugar before and after exercise. If exercise makes your blood sugar dip, don’t avoid exercise. Instead, have healthy snacks — like fruit — with you to avoid a serious drop. Juice, fruit, hard candy, or glucose tablets are all sources of quick sugar that can help if you’re feeling the effects of low blood sugar. Feeling tired, weak, or shaky are tell-tale signs. When your blood sugar drops (hypoglycaemia), your goal should be to get at least 15-20 grams of sugar or carbs. Avoid foods with sugar in combination with fat, like chocolate. Fat can slow your body’s ability to get the carbs it needs quickly enough. Carry “jelly beans” with you wherever you go, as sugar levels may go down without your knowing and jelly beans would be a lifesaver. In conclusion, go on a low GI diet and a daily exercise program if you desire to keep away from anti-diabetic medication for life.


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