Vegetarianism and Diabetes

Did you know?

• Vegetarians are, on an average, 25 per cent less likely to die of heart disease.

• Several studies have found that medication use significantly decreased when participants adopted any type of vegetarian or vegan diet.

• Vegetarian diet improves insulin sensitivity and lowers insulin dose.

• Vegetarian diet reduces cholesterol levels.

Who is a vegetarian?

Sari Edelstein, in her 2013 book, 'Food Science, An Ecological Approach' states that India has more vegetarians than the rest of the world put together.

Avegetarianissomeonewhodoesnoteatmeat,fish,orpoultryoranyproductthatcontainsthesefoods.Theyeatwholegrains,legumes(pulses),nuts,seeds,vegetablesandfruitswithorwithouttheuseofdairyproductsandeggs.Thereareactuallydifferenttypesofvegetarians:

•   Vegan - No meat or products from animals (including red meat, poultry, seafood or any product made with meat), eggs or dairy products.

•   Lacto-vegetarian - No meat or eggs, but they do consume dairy products.

•   Lacto-ovo vegetarian - No meat, but they do eat both dairy products and eggs.

Why be vegetarian?

For people with Diabetes, choosing to be vegetarian can be a healthy option. The key to eating a vegetarian diet when having Diabetes is ensuring you eat adequate amounts of protein and healthy fat, choose high fibre carbohydrates and manage portion control. Higher intake of vegetables, whole-grain foods, legumes, and nuts has been associated with a substantially lower risk of insulin resistance and Type 2 diabetes and improved glycaemic control in people who are insulin-resistant.

Type 2 Diabetes can occur as a result of sedentary and unhealthy lifestyle, poor diet control and obesity. Higher intake of vegetables, whole-grain foods, legumes, and nuts has been associated with a substantially lower risk of insulin resistance and type 2 diabetes and improved glycaemic control in people who are insulin-resistant as well as in those who are not. The key to eating a vegetarian diet when having diabetes is ensuring you eat adequate amounts of protein and healthy fat, choose high fibre carbohydrates and exercise portion control.

People become vegetarians for many reasons, including

•   health benefits

•   religious or cultural reasons

•   concern for animal welfare or the use of antibiotics and hormones in livestock

•   concern about the environment and sustainability (to avoid excessive use of environmental resources.)

•   taste - some people just don't like the taste of meat or fish.

What research tells us

A study published in the journal Current Diabetes Reports has found a link between Type 2 Diabetes and intake of red meat due to increased insulin resistance and overall lower glycaemic control.

After reviewing data from 87 published studies, authors Berkow and Barnard reported in Nutrition Reviews that a vegan or vegetarian diet is highly effective for weight loss. They also found that vegetarian populations have lower rates of heart disease, high blood pressure, diabetes, and obesity. In addition, their review suggests that weight loss in vegetarians is not dependent on exercise and occurs at a rate of approximately 1 pound per week.

Farmer et al. suggest that vegetarian diets may be better for weight management and may be more nutritious than diets that include meat. In their study published in the Journal of the Academy of Nutrition and Dietetics, they showed that vegetarians were slimmer than their meat-eating counterparts. Vegetarians were also found to consume more magnesium, potassium, iron, thiamin, riboflavin, folate, and vitamins and less total fat. The authors conclude that vegetarian diets are nutrient dense and can be recommended for weight management without compromising diet quality.

The Oxford component of the European Prospective Investigation into Cancer and Nutrition assessed changes in weight and BMI over a five-year period in meat-eating, fish-eating, vegetarian, and vegan men and women in the United Kingdom. During the five years of the study, mean annual weight gain was lowest among individuals who had changed to a diet containing fewer animal foods. The study also reported a significant difference in age-adjusted BMI, with the meat eaters having the highest BMI and vegans the lowest.

The Adventist Health Studies found that vegetarians have approximately half the risk of developing Diabetes as non-vegetarians. In 2008, Vang et al reported that non- vegetarians were 74 per cent more likely to develop diabetes over a 17-year period than vegetarians.

In 2009, a study involving more than 60,000 men and women found that the prevalence of Diabetes in individuals on a vegan diet was 2.9 per cent, compared with

7.6 per cent in the non-vegetarians. A low- fat, plant-based diet with no or little meat may help prevent and better manage Diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance.

A study in 2010 by Kahleova et al. examined the effects of a vegetarian diet versus a conventional diabetic diet in managing Type 2 Diabetes. In this 24-week randomized controlled trial, 74 patients who were randomly assigned to either a calorie- restricted vegetarian or a conventional diet, with meals provided. Patients were assessed at baseline, 12 weeks, and 24 weeks, with the second half of the study including aerobic exercise. At the conclusion of the trial, 43 per cent of those adhering to the vegetarian diet were able to reduce medication use compared to just 5 per cent in the control group. Those in vegetarian diet arm of the trial also had greater body weight reduction, greater insulin sensitivity, and greater subcutaneous and visceral fat loss.

An important component of Diabetes management is reducing cardiovascular disease (heart attack and stroke) risk, as those with Diabetes have a 2 to 4 times greater risk of suffering from heart related complications. A cross-sectional study published in the Central European Journal of Public Health found that those who adhered to a lacto-ovo-vegetarian diet had significantly decreased CVD risk factors, specifically blood pressure, serum cholesterol, and blood glucose levels

Fibre intake

When following a vegetarian or plant based lifestyle, you reduce the saturated and trans fats in your diet, which can reduce your risk of chronic disease. These types of fats can clog and damage arteries.

Dietary fibre is a type of carbohydrate that is found in plant-based foods. It's not absorbed or digested by the body, but plays an important role in maintaining good health. There are two types of fibre: soluble and insoluble.

•  Soluble fibre is the soft fibre that helps control blood glucose and reduces cholesterol. It also helps in managing diarrhoea. Soluble fibres are gums and pectins which are found in oats, legumes (dried beans and lentils), guar (made from cluster beans), barley, apples, guava, carrots and strawberries.

•  Insoluble fibre is the bulky fibre that helps to prevent constipation. It also helps to prevent some types of cancers. Insoluble fibres are cellulose, hemicelluloses and lignin which are present in whole wheat flour, bran, vegetables, and fruits.

Fibre-rich diet

Soluble fibre can help improve blood glucose management by slowing down digestion, leading to more stable blood sugar levels after eating. Those who are overweight or obese category, High-fibre foods tend to be more filling so you're likely to eat less and stay satisfied longer. They also take longer to eat and to be less "energy dense," which means they have fewer calories for the same volume of food.

Soluble fibre found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, or "bad," cholesterol levels.

Studies also have shown that high-fibre foods may have other heart-health benefits, such as reducing blood pressure and inflammation.

Insoluble dietary fibre as found in whole grain cereal products is considered to be especially effective in the prevention of Type 2 Diabetes Mellitus. A high intake of fruits and vegetables as well as pulses also exerts health-promoting properties. A

high-fibre diet also plays an important role in the prevention of obesity and coronary heart diseases.

Daily recommended allowance

Adults with Type 1 or Type 2 Diabetes may aim to consume 30 to 50 g of fibre every day. Children between the ages of three and 18 need a gradual increase in fibre intake, usually calculated by using the child's age and adding five grams.

Institute of Medicine recommends:

• For age 50 years or younger - 38 g/day for men and 25 g/day for women

• For age 51 years or older - 30 g/day for men and 21 g/day for women

Boost fibre intake in your diet

• Change to a breakfast cereal that is high in fibre; add some extra bran and fruits.

• Porridge oats are also a good choice as they contain soluble fibre.

• Curb afternoon cravings by eating fresh fruit with the skin on as a snack.

• Make food by adding fresh vegetables, barley, lentils and chickpeas.

• Keep the skin on fruits and vegetables, rather than peeling them. Remember to wash them well first.

• Use brown rice rather than the more refined white rice. Most fibre is contained in the outer layers of grains; the refining process removes these layers. Seeds and nuts can be a good source of added fibre.

• Read food labels to help you select those products that are higher in fibre.

Proteins matter

The Indian diet consists mainly of carbohydrates. Adequate dietary protein intake in Type 2 Diabetes is of specific importance. In people with Diabetes, insulin secretion, as well as its action, is reduced. In people with poorly controlled Diabetes, due to this insulin deprivation, there is an increase in both protein breakdown and protein synthesis. As the magnitude of the increase in protein breakdown is greater than the magnitude of the increase in protein synthesis, there is a net protein loss. Since proteins are relatively neutral with regards to glucose and lipid metabolism and they preserve muscle and bone mass,  it is very important to have adequate proteins in the diet.

Macronutrients - carbohydrates, protein and fats - are the essential building blocks of diet. Eating these in the right proportions is important for everyone including people with Type 2 Diabetes. A large number of cross-sectional as well as prospective and retrospective studies have found a significant association between macronutrient intake mainly carbohydrates and Type 2 Diabetes. Thus proteins and  fats have gained importance in the management of Diabetes.

The body uses protein to build, repair and maintain most of our body's tissues and organs. Proteins are also necessary for immune system function and they help some additional physiological processes. Typically, people with Diabetes don't need any more protein than people who don't have Diabetes.

As long as the kidneys are healthy, about 10-35 per cent of daily calories (0.8 to 1.0 g per kg body weight) should come from protein. This is the same amount suggested for a balanced non-diabetic diet. About 45-65 per cent of your caloric intake should come from carbohydrates and the rest should come from fat. People who have diabetic nephropathy often need to eat less protein. In this case, the recommended protein intake is about 0.8 g or less per kg of body weight.

Recommended protein intake, varying by age:

. 1 to 3 years: 15 g

. 4 to 6 years: 20 g

. 7 to 10 years: 28 g

. 11 to 14 years: 42 g

. 15 to 18 years: 55 g

. 19 to 50 years: 55 g

. Over 50 years: 53 g

Best protein rich vegetarian foods for people with Diabetes:

. Sprouts and pulses especially whole pulses

. Nuts and seeds

•  Low-fat yoghurt

•  Soya bean

•  Skim milk

•  Egg

Managing nutrition

Vitamin B12 deficiency

Vitamin B12 helps in the production of blood cells, maintenance of nerves and muscles and aids in the functioning of the brain. It also helps in stabilising body energy, breakdown of fats and proteins and elimination of toxic waste from the body. Vitamin B12 is also responsible for production of new DNA molecules (genetic material).

The recommended dietary allowance (RDA) of Vitamin B12 for:

• adults - 2.4 mcg

• pregnant women - 2.6 mcg

• lactating mothers - 2.8 mcg

Children of different age groups have varied requirement of Vitamin B12 intake.

• For children of 1-3 years - 0.9 mcg

• For 4-8 years - 1.2 mcg

• For 9-13 years - 1.8 mcg

• For 14-18 years - 2.4 mcg

Vitamin B12 deficiency may cause chronic fatigue, tiredness, muscle weakness, pain, numbness, tingling sensation, paralysis and co-ordination problems such as in peripheral neuropathy. It may also cause tiredness, giddiness and sometimes breathlessness, also known as megaloblastic anaemia. Inflammation of the mouth, stomach and intestines may occur due to Vitamin B12 deficiency. Vitamin B12 deficiency may also lead to memory problems, difficulty concentrating, confusion, irritability, depression and disconnect from reality.

Most sources of Vitamin B12 are derived from animal-based foods. Hence, supplementation becomes essential in people following a vegan or vegetarian diet. Also, only a part of the vitamin intake is actually absorbed, hence higher doses for the treatment are required.

Vitamin B12 supplementations are available in various forms. Vitamin B12 is available in the form of pills, capsules and injections. Out of these, the standard treatment is with medications and in severe deficiency cases, injections are recommended. Injections help in replenishing the deficiency quickly and are thus preferred for severe deficiency.

Zinc deficiency

Zinc plays a crucial role in many bodily functions, including immune system support, wound healing, and cell division. Zinc is an essential trace element that plays a vital role in maintaining overall health and well-being. It's involved in numerous biological processes and functions that keep our bodies running smoothly.

Zinc is crucial for:

.    proper functioning of the immune system.

.    protecting cells from damage caused by free radicals.

.    the process of cell division, growth, and repair.

.    the production of collagen, a protein that is integral to the structure and strength of your skin.

.    regulating the production of sebum, which is the oil produced by your skin's sebaceous glands.

.    protecting your skin from damage caused by environmental factors, such as UV radiation and pollution.

.    production of testosterone and sperm health in men.

.    hormone regulation and the proper functioning of the menstrual cycle in women.

.    brain functions such as neurotransmission, learning, and memory.

. your body's metabolism by assisting in the breakdown of carbohydrates, proteins, and fats.

.    production of adenosine triphosphate (ATP), which is the body's primary source of energy.

.    maintaining strong and healthy bones.

.    being a component of many enzymes that are involved in taste and smell perception. A deficiency in zinc can lead to a reduced ability to taste or smell, affecting your overall enjoyment of food.

Note: Keep in mind you may still need a zinc supplement to get your daily dose of 8 mg (for women) or 11 mg (for men). Ask your doctor before starting a zinc supplement as too much zinc can lead to nausea and vomiting.

Iron deficiency

Iron is the most common nutritional deficiency and the leading cause of anaemia. The body absorbs two to three times more iron from animal sources than plant sources, so vegetarians can have a hard time getting the iron they need. Iron has a very important role in transporting oxygen throughout our blood to maintain our energy levels. Symptoms of an iron deficiency include fatigue, dizziness, headache, pale skin, weakness, and sometimes cravings for weird things, like ice and dirt.

The Recommended Dietary Allowance (RDA) for adults 19-50 years is 8 mg daily for men, 18 mg for women, 27 mg for pregnancy, and 9 mg for lactation.

Adolescents 14-18 years actively growing also need higher iron: 11 mg for boys, 15 mg for girls.

The RDA for women 51+ years is 8 mg.

Note: Keep in mind you may still need an iron supplement. Ask your doctor before starting an iron supplement.

Omega-3 fatty acids deficiency

Omega-3 fatty acids are a group of three important types of fat: ALA (alpha-linolenic acid), DHA (docosahexaenoic acid), and EPA (eicosapentaenoic acid). Omega-3 fatty acids has anti-inflammatory effects, (particularly DHA) are vital for your brain and retinas.

ALA is found in foods like flax seeds, flaxseed oil, canola oil, chia seeds, walnuts, hemp seeds, and soybeans.

Eicosapentaenoic acid (EPA) is mostly found in animal products, such as fatty fish and fish oil. Docosahexaenoic acid (DHA) is the most important omega-3 fatty acid in your body. Like EPA, it occurs mainly in animal products like fatty fish and fish oil.

Meat, eggs, and dairy from grass-fed animals also tend to contain significant amounts. Vegetarians often lack DHA.

The recommended dietary allowance for ALA is 1.6 g per day for men and 1.1 g per day for women. A minimum of 250 to 500 mg combined EPA and DHA each day for healthy adults. An additional 200 to 300 mg of DHA is recommended during pregnancy and nursing.

Riboflavin deficiency

Riboflavin, also known as vitamin B2, plays a role in energy production, growth and development, and metabolism. Riboflavin is an essential part of two major coenzymes in the body: flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). These enzymes produce energy in the body, help with growth and development and also Break down fats, drugs, and steroids.

Riboflavin also helps to maintain normal homocysteine levels. High levels of homocysteine have been associated with heart disease. Homocysteine is an amino acid that the body produces. Most people have low homocysteine levels. This is because the body breaks down the amino acid quickly into other compounds. High, or elevated, homocysteine levels are known as hyper homocysteinemia. This could indicate a person has a vitamin deficiency, as the body needs certain nutrients to break it down.

Riboflavin is available in many dietary supplements. Multivitamin/mineral supplements with riboflavin commonly provide 1.3 mg riboflavin. Supplements containing riboflavin only or B-complex vitamins (that include riboflavin) are also available.

 Note: It is important to take supplements only on the advice of your doctor as various health parameters need to be considered. Please do consult your doctor before starting or modifying nutritional supplement dosage.