Sunday, January 4, 2009

Fruits and Diabetes

The rise of diabetes in Brunei is pretty scary. I remembered most of the cardiac patients I used to look after in GJPMC had history of diabetes 2. And even then, most of them were unaware of the foods they were supposed to eat. I was even more surprised the food offered to the patients post surgically after cardiac bypass. Back in UK, we had patients eating lovely sauteed chicken ( reduced salt in gravy) and steam vegetables. For dessert, they had a choice of 'Del Monte' bananas or small tub of dates. But I remember the meals having 'taste' to it whereas the food served at hospitals here are bland or not nutritious at all. Lacking protein or just the portion of it.

The consultants in the Cardiac Center in London were advising patients to eat fruits. They didnt' put a limit to it. Neither did the nutritionists. What I'm wondering is, why were the cardiac patients in GJ limited to less than a cupful of fruits per meal? They would be served a large portion of 'watery rice' or 'bubur' and less than a handful of chicken or fish slices with bland veggies. Most of the food would go untouched as there weren't any salt added to the food either.

When I worked in UK, patients were given food with 'taste' and encouraged to eat fruits. There wasn't a limit to it. And if the patients refused to eat, the doctors would give the go ahead for the patient's family to bring their own home cooked food for the patient. Reason is, the surgical wound depends on the patient's nutritional intake. None or little food means slow recovery.

I understand fruits have sugars, but surely I would rather the patients eat 'fructose' and be fed while in hospital rather than losing complete appetite and recover slowly or at worse catch a hospital infection due to prolong stay in hospital.

The doctors here may arguably say they need to control patient's blood sugar level while in hospital, but shouldn't they determined what was a 'normal' blood sugar for the patient prior to admission? And it's impossible to change a person's diet within one day. I think patient education would be the best thing.

Ps:- If any of you are diabetics, it's always good to eat everything in moderation and think wisely what will 'feed' your body with 'nutrition' rather than feeding the hunger pangs. Try taking meals in smaller amounts but frequent throughout the day.

I tried to google whether fruits are good for diabetics, and the best result or explanation I came across was as below.

Diabetics often ask whether it is safe for them to eat large quantities of fruit. Many people suffering from diabetes avoid eating fruit because they are worried about the high sugar content found in most fruits. Fortunately, there are many fruits a diabetic can enjoy which do not significantly affect blood glucose levels.

Good Fruits For Diabetics

Fiber rich foods are general safe for diabetics to eat because they tend to have a lower glycemic index (GI) and therefore do not spike blood sugar levels to the same extent as high GI foods. This is because fiber slows down the absorption of sugar into the blood stream. Fiber rich fruits tend to be fruits with edible skins and seeds as it is these parts of the fruit that are highest in fiber. Fruits high in fiber include (fiber content in brackets): apples (2.3%), pears (2.1%), apricots (2.1%), blueberries (8.4%), kiwifruit (2.1%), and pomegranates (3.4%).

Fruits high in fructose, and those with high fructose to glucose ratios are also beneficial to diabetics because fructose does not require insulin to metabolize and therefore can be enjoyed by insulin resistant diabetics. High fructose fruits include apples, pears, guavas and mangoes, - all of which have fructose to glucose ratios greater than 2.

Along with high fiber and fructose levels, apples have added benefits for people with diabetes. Raw apples contain high amounts of pectin which has been shown to improve glycemic control in diabetics, reducing insulin requirements by up to 50% in some cases.

Grapefruit is another fruit which may be beneficial for diabetics. Grapefruit can promote weight loss which in turn helps reduce insulin resistance. According to the Scripps institute, grapefruit may also help control insulin levels when consumed during meal times.

Bad Fruits For Diabetics

Fruits with high amounts of glucose should be eaten only in small amounts as they can spike blood glucose levels however most can still be enjoyed as part of a healthy diabetic meal plan. High sugar fruits include bananas, dates, grapes, watermelon, and oranges.

Likewise, fruit juices tend to be stripped of the pulpy fibrous parts of the fruit and therefore tend to be very low in fiber and very high in sugar. Many fruit juices manufacturers also add sugar to their fruit juices to the extent that some fruit juices have higher sugar levels than carbonated sodas.

Dried fruits also tend to spike blood sugar levels to a larger extent than fresh fruit due to their high sugar content. Canned fruits in syrup also tend to be high in sugar and therefore should be eaten in moderation or drained of the syrup before consuming.

The close association between sugar intake and diabetes has led to a few misconceptions about diabetics and their diet restrictions. Most diabetics can eat the same foods as those without the disease, but the question becomes how much and how often. Diabetics can indeed eat fruit, and in fact are strongly encouraged to choose fruit over more processed foods high in sugars and other carbohydrates. Fruit contains natural fiber, vitamins, enzymes and other essential nutrients that diabetics need to maintain a normal lifestyle.

The assumption that fruit would be dangerous for diabetics stems from the relationship between sugars and insulin levels. Insulin is designed to break down sugars and carbohydrates, but certain foods contain higher levels of these chemicals and demand more insulin production to break down. Many diabetics cannot produce enough natural insulin to handle a high amount of carbohydrates or sugars at one time. Diabetic menus take into account the relative amount of sugars and carbohydrates present in foods, also known as a glycemic index.

The majority of common fruits have a low to medium glycemic index, which means most diabetics can safely metabolize the fruit sugars through natural insulin production. A few fruits, such as dried dates, may be relatively high on the glycemic index, but they can still be eaten in moderation. The key to eating fruit on a diabetic diet is to space out the portions over the course of a day. Eating too many sweet fruits at once could be problematic for insulin-dependent diabetics, but in general most fruits should not create a dangerous spike in blood sugar levels.

Fruits such as apples and oranges provide fiber as well as fructose or fruit sugar. It can be a challenge for diabetics to get enough fiber in their diets because many foods high in natural fiber may also be high in starch, sugar or other high glycemic ingredients. Fruit can also satisfy diabetics' cravings for processed sweets such as doughnuts and cakes. A cupful of grapes or a medium size apple between meals can help diabetics maintain their blood sugar levels without creating sudden spikes that can overwhelm an already overworked insulin-producing pancreas.

PPS:- Here's two useful websites, diabetic fruits pyramid to follow through and the latest diabetic food update from Mayo Clinic regarding diabetic diets

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