Fasting safely with diabetes
Most people with type 2 diabetes whose diabetes was well-controlled before Ramadan can safely observe Ramadan fasting is the finding of recent study. UK dietitian Azmina Govindji agrees. ‘It is possible to fast safely if you are careful about managing your diabetes,’ she says.
‘The reason why you need to take care is that some drugs used to treat type 2 diabetes (sulphonylureas) and insulin can make your blood glucose level drop too low when you are not eating. Not drinking enough water can also make you dehydrated. Often the evening meal, Iftar, contains lots of carbs and perhaps sugary drinks. Because this is a time when families eat together to break the fast, the food is richer than you may be eating normally. And you may feel having fasted all day, you have an excuse to reward yourself. You need to be particularly strong willed at this time.’
Azmina’s fasting checklist
- Seek the advice of your healthcare team before starting and at the end of the fast, since they may advice you to change the times or amount of medication you take.
- Do not stop taking your medication.
- Avoid eating lots of unhealthy foods as a reward! Try and maintain a healthy eating pattern after you break the fast. Make sure that you have lots of fruit and vegetables and dal as these are slowly digested and help your blood glucose to rise more slowly too. Remember to drink plenty of fluids.
- Divide your daily food intake into two equal portions, one to be taken at Sehri and one at Iftar
- Remember to check your glucose level regularly, at least once a day at different times of the day.
- After the period of Ramadan, it is essential that you visit your doctor to make sure that your blood glucose is being controlled adequately and also to check whether your medication needs to be adjusted.
Yogurt chicken with fresh fenugreek (pictured above) is from Azmina’s most recent book (with Sanjeev Kapoor) Healthy Indian Cooking for Diabetes. It is available from bookstores in the UK, from Amazon and in Australia online from Great Ideas in Nutrition.
Does diet play a part in Parkinson’s disease?
Parkinson's disease or PD (named after English physician James Parkinson, who gave a detailed description of it in 1817 in ‘An Essay on the Shaking Palsy’) is a chronic, progressive, degenerative disease of the brain that affects movement and coordination.
It occurs when the dopamine-producing cells in a part of the brain called the substantia nigra begin to malfunction and die. Dopamine is an important neurotransmitter (think of it as a chemical messenger) that whizzes information to the parts of the brain that control movement and coordination. When the cells begin to die and the amount of dopamine decreases, messages from the brain telling the body how and when to move are delivered more slowly, producing the typical symptoms of PD – tremor, stiffness, slowness of movement (bradykinesia), unsteady walking and poor coordination.
We don’t know what causes PD. It’s thought that genes play a part in some cases, but that environmental and lifestyle factors are likely to be responsible for the most part.
Recent research has suggested that ‘insulin may increase dopamine transporter mRNA in the substantia nigra and regulate brain dopamine concentrations. Thus high GI or GL carbohydrates might be expected to decrease the risk of PD by an insulin secretion-induced increase in brain dopamine,’ suggest Japanese researchers in the journal of Nutrition.
‘This hypothesis appears reasonable given that the prevalence of PD is generally lower in East Asian regions (China, Taiwan, and Japan) where white rice, a food with a high GI, is a staple food and thus dietary GI and GL appear to be relatively higher than in western regions (Europe and the US), where rice is not a staple,’ they write.
The Japanese study, which was based on what the participants reported eating in the previous month, found that people on a high GI diet were less likely to have PD than those on a low GI diet. The researchers acknowledge the limitations of the study and the need in future studies for an accurate assessment of past dietary habits.
We asked Dr Simon Thornley (Public Health doctor and researcher from the University of Auckland) to comment: ‘In many case control studies including this one, the researchers assess the patient’s diet at the same time as they look at his or her symptoms,’ he said. ‘So cause and effect can be confused. In this study the effects are actually quite small, so the result may be due to other things that they didn’t measure, so what’s called ‘confounding’ or mixing of effects may play a part in their results.’
‘Glucose is known to stimulate dopamine release in the mid brain. Lack of dopamine is a problem for those people with Parkinson's disease. High GI foods may mask or delay Parkinson's disease by stimulating more dopamine release. The dopamine excess from high GI food may protect a small proportion of people that would have gone on to develop Parkinson’s disease from becoming symptomatic and diagnosed. Many questions are still unanswered from this study but it is an interesting hypothesis and more studies are definitely needed. And it is far too early to rush out and tuck into a high GI diet. Remember, the really big problem we face as a community is diabetes.’
Beans benefit glycemic control
Whether you buy them dried or opt for canned convenience, beans, chickpeas, peas and lentils (called pulses or legumes) are one of nature’s lowest GI foods. They are high in fibre and packed with nutrients including protein, carbohydrate, B vitamins, folate and minerals. When you add them to meals and snacks you reduce the overall GI of your diet because your body digests them slowly – primarily because their starch breaks down relatively slowly (or incompletely) during cooking and they contain tannins and enzyme inhibitors that also slow digestion.
University of Toronto researchers looked at the evidence that pulses benefit glycemic control in a meta-analysis published in Diabetologia. They report that alone or in low-GI or high-fibre diets, pulses do make a difference in managing blood glucose. However, because they found ‘significant inter-study heterogeneity,’ they call for further trials. (‘Heterogeneity’ means dissimilarity between studies. It can be because of the use of different statistical methods, or evaluation of people with different characteristics, treatments or outcomes.)
GI Group: Pulses or legumes are an important part of a low GI diet which is why it’s a good idea to try and include them in your meals at least twice a week as a starchy vegetable alternative – more often if you are vegetarian or vegan. One serve is equivalent to ½ cup cooked beans, lentils or chickpeas.
Imagining a world where we eat less meat
By Jess Halliday
Cutting back meat consumption is the new darling cause of pop stars. But if necessary environmental and health goals are to be achieved, the whole supply chain needs to be strumming along in tune. The full article is available HERE.