Reduce sugar is the catchphrase heard frequently to manage diabetes, so much so that as the festive season approaches, sweet shops are bringing out low-sugar delicacies. ‘Natural’, ‘no sugar’ and ‘diabetic-friendly’ options abound — a testament to the staggering burden India is dealing with.
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What happens though, when you add a significant quantity of fibre to your diet when you have diabetes? A survey attempted to find the answer.
‘STAR’ (Survey for Management of Diabetes with Fibre-rich Nutrition Drink), a pan-India survey, was conducted amongst 3,042 people with Type 2 diabetes, the results were published in the Indian Journal of Clinical Practice in August.
The survey categorised people with diabetes into two groups: one group that was given and consumed a medical-grade high-fibre supplement for a minimum of three months, and the other group that did not. It found that people with diabetes who took the supplement, reported significantly lower HbA1C (blood sugar) levels and higher weight loss, along with feelings of satiety, compared to those who did not consume the supplement. The survey was supported by Hindustan Unilever, a company that sells health food drinks.
Increasing the fibre in your diet to manage diabetes is nothing new: studies across the world have shown the role of fibre in not just controlling blood glucose, but also lowering cholesterol levels, and maintaining digestive health. Because the body cannot absorb and break down fibre, it helps with a slow, sustained release of energy, preventing a spike in blood sugar levels. It also helps your gut microbiome, and increases your feeling of being ‘full.’
The problem is, says Sanjay Kalra, president, the South Asian Federation of Endocrine Societies and lead author of the survey, most people with diabetes do not get the required amount of fibre.
The Research Society for Study of Diabetes in India (RSSDI), in its Clinical Practice Recommendations 2022 for medical nutrition therapy, states that fibre intake should be 25 to 40 grams per day, while carbohydrates should be limited to 50-60% of total calories.
However, in most Indian diets now, carbohydrates form 70 to 80%, says Dr. Kalra. “This was not an issue earlier, with traditional diets that relied on whole grains. Now however, fibre consumption has decreased while carbohydrate consumption remains the same. What is also concerning, is that a lot of the carbohydrates consumed are from ultra-processed food.”
What constitutes fibre?
According to an article on the Centers for Disease Control and Prevention’s website, fibre is soluble and insoluble. Both have health benefits.
Soluble fibre dissolves in water and slows down digestion. It helps control blood sugar and cholesterol. It is found in fruits like apples, bananas and guavas, and in oats, peas, carrots, black beans, kidney beans and figs.
The other kind, insoluble fibre, does not dissolve, and typically remains whole as it passes through your stomach. It supports insulin sensitivity and helps keep your bowels healthy. It is found in whole wheat flour, nuts, seeds, lentil and vegetables like cauliflower.
The cost factor
Fruits, vegetables and nuts are more expensive compared to carbohydrates, points out Nihal Thomas, senior professor, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore. This, he said, makes healthy diets unaffordable for a large number of people in the country who rely on cheaper, carb-heavy foods, thereby contributing to the diabetes burden — 10.13 crore people in our country of 140 crore could potentially be diabetic, as per latest estimates. Prof. Thomas called for policy changes to make healthier foods more affordable.
Incorporating it in your diet?
About 25 to 40 grams of fibre per day may sound daunting, especially when you realise that one medium apple, with its skin, has only about three to four grams of fibre.
The idea, says the CDC, is to spread your fibre intake among different foods throughout the day. This may perhaps mean incorporating oats and nuts into your breakfast, opting for whole grains, choosing non-starchy vegetables and snacking on seeds. But it also cautions people to make this move slowly: too much fibre too soon, can lead to bloating and constipation. And remember, drink lots of water!
