Diet for an elderly diabetic

A diet plan is an essential part of any diabetic’s treatment. As we found out in our previous interview with Dr. Anoop Amarnath, Consultant Geriatrician at Apollo Hospitals, diabetes can be life threatening if not well-managed. Hence we decode the dynamics of a diabetic’s diet in this interview with Dr. Priyanka Rohtagi, Chief Clinical Nutritionist, Apollo Hospitals.

Flaxseeds are good for diabetics. Pic: Silvertalkies

Why is diet an essential part of a diabetic’s treatment plan?

A diabetic diet is a healthy meal plan where the importance of small and frequent meals, with a good mix of carbohydrates, protein and fats is essential. It needs to be low on glycemic index and should have a good distribution of carbohydrates.

How does a diet plan help? Can it reverse diabetes or only control and prevent?

A diet plan helps prevent malnutrition and adds to the quality of life. Though diabetes can’t be cured, it can be kept well within control thereby making it possible for the patients to carry on with minimal medication and regular monitoring.

Would a diet plan for an elderly and a young diabetic vary? If yes, how?

Elderly need to be more careful as they are vulnerable to fall into the trap of malnutrition. With decreased metabolism, peristalsis and absorption, it is essential to get a customised plan based on one’s biochemical and physical parameters.

On what basis is a diet plan charted out for a diabetic patient? (Any considerations like BMI, gender etc.?)

Diet plan is made considering ones’ body weight, height, BMI, activity levels, age, gender, physiological state, disease history and biochemical values.

Any thumb rules or tips for a diabetic’s diet?

Staying hydrated is important for a diabetic. Pic credit: Wikimedia Commons

1. Small frequent meals.
2. Well distributed carbohydrates throughout the day.
3. Adequate hydration
4. Diet supporting maintenance of ideal body weight.
5. Medium glycemic index (a good mix of all the nutrients).
6. More of complex carbohydrates.

Which foods are must haves, if any?

1. Complex carbohydrates (whole grains, pulses, vegetables and greens)
2. Essential fatty acids like flaxseed (pictured above), almonds, fish
3. Adequate proteins throughout the day (good quality protein is the key)
4. Adequate fluid intake.

Which are the forbidden foods, if any?

1. Exclusive intake of simple carbohydrates like honey, jaggery ,sugar, jams
2. Trans fats (hydrogenated fat present in bakery products and repeated use of fried oil)
3. Excess calories, fatty foods, alcohol, nicotine, caffeine.

Any dos and don’ts with regards to drinks, dairy products etc.?

It is essential to know the food that you eat, especially the preserved and processed foods.

Choose natural beverages- homemade soups, buttermilk, rasam. Avoid ready to drink preparation as there may be additional hidden salt, sugar used to add to the shelf life. Avoid artificially sweetened drinks, ice-cream, chocolates and sweets.

Any guidelines on use of spices and seasonings?

All Indian spices are full of nature’s goodness, so need to be used. Over-use of any ingredient may cause problems.

Any directive on frequency of meals and portion size?

A diabetic must have small meals, every three hours. Portion size varies from person to person based on the requirements. However one should prevent both fasting and feasting.

How strictly should a diet plan be followed?

It is a matter of portion control and moderation is the key.

Any other preventive measures to be taken?

1. Regular monitoring of sugar level.
2. Regular intake of medication
3. Regular exercise

Diabetes diet and associated myths, if any?

Diabetic diet is a healthy way of life. A diabetic can eat normal food as anyone else in the family. It need not be bland. Also occasional intake of sugar is fine.

What is a glycemic index and how does one keep track of it while choosing food?

Glycemic index (GI) is a numerical scale that measures how fast blood sugar levels rise after eating a certain food.

Foods low on glycemic index do not increase the sugar immediately in the blood stream.

An Indian meal with dal, vegetables and whole grains is medium on GI. Ensure 50 per cent of the cereal intake as whole grains or multigrain.

Green leafy veggies are on the must-eat list. Pic: Silvertalkies

DIETARY ADVICE FOR A HEALTHY LIFESTYLE

• Consume toned milk, at least 500ml, daily (including coffee, tea). Do remove cream from the milk.
• Use whole grains and pulses rather than refined cereals like maida (all purpose flour).
• If mixing cereals with pulses for chapatti, use in the following proportion-(4 parts of cereal + 1 part of the soya atta)
• Ensure liberal intake of green leafy vegetables in the form of salads, soups, cooked vegetables as sabzis etc.
• Ensure judicious intake of roots and tubers (like potatoes, colocasia (arbi), sweet potato, yam, etc.).
• Select snacks that are roasted like steamed sprouts, poha.
• Preferably consume at least 2 litres of water every day.
• A gap of 2 hours after dinner is required, avoid going to bed immediately.
• Cultivate the habit of having food at regular and shorter intervals and in small quantity, like 3 major meals and 3-4 small snacks in between.
• Avoid late dinner and bulky meals.

AVOID

Avoid sweet bakery products frequently. Pic: Silvertalkies

• Extra sugar in the form of excess coffee, tea, sweets, glucose, honey, jams, jellies, candies, ice creams, soft drinks and other sweetened beverages.
• Avoid deep fried foods like samosa, kachori, namkeen, paranthas or wafers and bakery products on a daily basis.
• Avoid red meat like lamb (mutton), egg yolk, prawns, crab and organ meat.
• Avoid dried fruits like groundnuts, til, pista, coconut, and cashews, etc.
• Extra salt on the table (top salt), daily consumption of pickle, papads, ready to eat foods, processed foods, salted nuts, salted fish and chutney powders which contains salt as a major preserving agent.

SAMPLE MEAL PLAN FOR THE DAY

Morning 6.30 – 7:30am1 glass luke warm water (200 ml) + 1cup tea/ coffee/ milk without sugar + 2 multigrain biscuitsBreakfast 8:00 – 8:30 amChapathis-2 +vegetable- 1cup /Poha- 1½ cup / Upma- 1½ cup with vegetables / Vegetable preparations, OR multigrain TOASTED Bread 2 slices / GRILLED Veg Sandwich-2 slices + cucumber, tomato, carrot/ 1 cup wheat flakes/ Muesli with milk (prefer the previous day’s milk as buffaloes milk is very high fat) / Oats upma/ porridge-1 cupMid-morning 10:30 amRoasted chana/ buttermilk(chhaach)/sprouts/fruitLunch 1:30 – 2:30 pm1 glass water +1 bowl salad +Stuffed Palak/ Methi Chapathi- 2-3 + Dal /Sambhar/ greens dal + Vegetable Preparation + curd/ buttermilk.Evening Snack  4:30 – 5:30 pm1 cup tea/ coffee / milk + popcorn (plain) / 1biscuit (5 grain biscuit/ hi-fibre)Dinner 8:00 – 9:00 pmSame as lunch (avoid rice)Bedtime 10:00 -10:30 pmMilk

Dr. Priyanka Rohatgi, M.Sc, PhD, ADND, PGCCGM (XLRI) is Chief Clinical Nut ritionist and HOD, Dept. of Nutrition and Dietetics at Apollo Hospitals, Bangalore. She is also President, Indian Dietetic Association , Bangalore Chapter.

– Interviewed by Nidhi Chawla