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corresponding author e-mail: dhanvantari86@gmail.com
DIET AND LIFESTYLE GUIDELINES FOR DIABETES: EVIDENCE
BASED AYURVEDIC PERSPECTIVE
Rohit Sharma , Prajapati PK
Department of Rasashastra and Bhaishajya Kalpana, I.P.G.T. & R.A.,
Gujarat Ayurved University, Jamnagar, India
received:
September 13, 2014
accepted:
October 24, 2014
available online:
December 15, 2014
Abstract
Background and Aims: Ayurveda strongly emphasize on preventive and promotive
aspects of health rather than curative. Centuries ago, Ayurveda laid the concepts of
Dinacharya (daily regimen for healthy living), Ritucharya (seasonal regimen for healthy
living), Sadvaritta (moral conducts) and Achara Rasayana (social conducts) as well
established guidelines for healthy diet and lifestyle; but in current era, hardly anyone
aptly follow it. As a result, there is tremendous rise in lifestyle disorders as pandemics,
diabetes being the most menacing among them. The aim of this review is to bring into the
limelight the Ayurvedic dietary and lifestyle guidelines for prevention of type 2 diabetes
and available factual research evidence validating it. Materials and methods: Ayurvedic
recommendations for prevention of diabetes were rationally reviewed in light of
published information from several articles. Publications in Pubmed, Scopemed, Dhara
online and other allied databases covering fields of therapeutics, pharmacology,
biomedicine and health were also screened and taken into study for the report.
Conclusion: Ayurvedic lifestyle guidelines of adopting a healthy dietary pattern together
with physical activity are valuable tools in the prevention of type 2 diabetes.
key words: Ayurveda, Diabetes Mellitus, Diet, Lifestyle, Madhumeha.
Introduction
All polyuric diseases in Ayurveda are
described under ‘Prameha’, and Madhumeha is
one amongst them, equated to Type 2 Diabetes
Mellitus. The description of the acquired form of
Prameha; refered to as Apathyanimittaja
Prameha, is very similar to type 2 diabetes.
Apathya Ahara (dietetic incompatibilities/
unwholesome diet) and Apathya Vihara
(lifestyle incompatibilities) both are the major
risk factors for Madhumeha [1].
Diabetes Mellitus is the most threatening
endemic lifestyle disorder, having social,
medical and economic ramifications globally. As
per a recent report of the International Diabetes
Federation, each year 3.8 million deaths are
attributable to diabetes and related
complications; at least 50% of diabetics are
unaware of their condition (indicating lack of
awareness); and up to 80% of type 2 diabetes is
preventable by adopting a healthy diet and
increasing physical activity [2]. Studies have
proved that active participation of the patients in
the form of lifestyle changes can result in less
© 2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania
http://www.jrdiabet.ro
Rom J Diabetes Nutr Metab Dis. 21(4):335-346
doi: 10.2478/rjdnmd-2014-0041
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expense for the management of diabetes and
ensure good glycemic control also [3].
Each person needs an individualized
treatment. Insulin or oral hypoglycemic agents
are only prescribed for Type 2 diabetics if diet
and exercise alone fail to lower the glycemic
level. Ironically, drug approach could not cure
disease condition or prevent further progress of
disease and in spite of good glycemic control,
patient lands into life threatening complications.
Besides that, conventional antidiabetic drugs are
either expensive or often associate adverse
effects. Therefore the key for management is to
consult a doctor and a dietician, which means
adjusting one’s diet, activity, and sometimes
taking medication [4].
Substantial evidence now exist to suggest
that diabetes is strongly associated with
increasing urbanization, population growth,
aging, patient’s unhealthy lifestyle choices,
reduced physical activity, obesity, behavioral
patterns, socioeconomic changes and perhaps
most importantly a ‘Western style’ diet [5,6].
Type 2 diabetes is a largely preventable disease
and intensive lifestyle interventions are not only
highly effective but cost-effective too. Here,
Ayurvedic Pathya Ahara (wholesome diet) and
Pathya Vihara (wholesome lifestyle) can play a
major role in disease prevention.
Taking these facts into consideration, the
present review was undertaken to bring into the
limelight the role of suitable Ayurvedic dietary
and lifestyle guidelines to prevent diabetes in
view of the available evidence based supporting
data.
Matherials and methods
Search strategy and Inclusion criteria
Diet and lifestyle related etiologies
accountable for diabetes as mentioned in
Ayurvedic treatises were rationally reviewed
along with recommendations of Pathya Ahara
(wholesome diet) and Pathya Vihara
(wholesome lifestyle) as preventive strategies.
The search was conducted in light of
contemporary scientific supporting data
available in electronic and internet media for
possible justification and validation of these
Ayurvedic principles. Publications in Pubmed,
Scopemed, Dhara online and other allied
databases covering fields of therapeutics,
pharmacology, biomedicine and health were also
screened and taken into study for the report.
Information extracted from original articles,
review works, randomized control trials (RCTs)
and meta-analyses including reports of
experiments on humans and animal model
systems and cross references were collected.
Searches were not limited by date or place of
publications but to publications in English
language.
Results
Diet related etiologies and contraindicated
Apathya Ahara in Ayurveda
Excessive use of curds, flesh of animals of
domestic, aquatic and marshy places, use of
dairy preparations, new water (water of rivers
and tanks during rains and floods), new grains,
puddings made of jaggery/sugar and using more
similar factors (heavy diets, fatty foods that
increase body weight, cholesterol and causes
obesity etc.) which increase Kapha Dosha [7]. In
addition, the foods / drinks which increase
Medas (adipose tissue), Mutra (urine), and diets
which are sweet, sour, salty, fatty, not easily
digestible, slimy, cold, drinks like beer and
molasses were also considered as the causative
factors [1,8]. In another context it is said that
excessive intake of dry substances (Ruksha
Ahara), light food (Laghu Ahara), excessive use
of pungent, bitter, cool items, excessive fasting
etc. increase Vata and also cause Madhumeha
[9]. According to Ayurveda, there are mainly
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two types of diabetic persons: Sthula (obese) and
Krisha (lean and thin), both having different
etiology and lifestyle intervention.
Contraindicated Apathya Ahara for diabetes
are: alcohols like Sauveera, Sukta, Maireya and
Sura, milk, milk products, oil, ghee, sugarcane
juice or sugar, jaggery, alkaline, curd, grain
cakes (Pishta), sour substances, sweet drinks
(Panakas), and meats of domestic, aquatic and
swamp animals [10].
Contemporary supporting data
Evidences have proved that high fat (total
and saturated) and meat intake were associated
with a higher risk of type 2 diabetes. High fat
or oil intake is reported to decrease the
favorable high-density lipoprotein (HDL)
cholesterol levels in the blood and may
adversely affect the lipid profile [11,12].
This
supports Ayurvedic claims on the role of fatty
items, marshy animals, aquatic animals (which
are heavy with fats) and milk items in diabetes.
It is reported that, bakery and dairy products,
sugar/sugar items, jaggery, molasses, alcohol
(wine, beer) and sugar added foods are
predisposing factors for diabetes [13-16]. These
foods immediately burden the beta cells of
Langerhans, can lead to insulin resistance, etc
[17]. Reports linking bovine serum albumin
(BSA) antibodies and diabetes suggest that milk
protein have a strong diabetogenic effect. In
some cases, bovine serum albumin may cross-
react with a protein (P.69) which can be induced
on pancreatic beta cells membrane by the
inflammatory mediator interferon gamma [18].
This study also supports the Ayurvedic concept
that the excessive use of milk and milk products
may cause diabetes.
In the current era, people are fond of flour
preparations, sweetened drinks, refrigerated,
preserved and reheated food items, due to the
busy schedules of society today, wherein they
hardly have time to eat at home. Such food is
low in fiber, high in glycemic loads and is
associated with increased risk of diabetes [19].
Adhyashana (over eating) is also proved as a risk
factor for DM [20]. T
hese dietary irregularities
further contribute to disturb the carbohydrate
and lipid metabolism and result in Madhumeha
in susceptible individuals.
These studies
confirm the Ayurvedic etiology for diabetes.
WHO identified one particular type of
Diabetes as ‘Malnutrition Related Diabetes
Mellitus’, which is common in India. Most of
these patients are lean and thin young adults
between 15 to 35 years age and more often
reported in Kerala and Orissa states [21,22]. This
type can be correlated to Krisha Pramehi. It is
presumed that diabetes is mainly caused by
heavy food which increases Kapha, Medas etc.
But Ayurveda also emphasized that excessive
starvation and intake of dry substances can also
cause another variety of Prameha (diabetes).
In Northern Europe and North America Ice
lands, the unusual rise of type 1 diabetes in
children born in the month of October was
hypothesized to be explained by the high
Nitrosamine content of smoked mutton
traditionally used at Christmas. In mice
experiments it was proved that, this effect was
mediated via the parental germ cell rather than
by direct effect on pancreatic beta cells of fetus
[23]. The Ayurvedic literature cautioned that,
mutton of marshy lands might cause Prameha
hence to be restricted. Nevertheless, more
confirmative studies are required.
Ayurvedic Diet and lifestyle protocols
for diabetes
(1) First and foremost guideline is to avoid
the diet and lifestyle related etiological factors
involved in type 2 diabetes (Nidanaparivarjana)
[7]. (2) Sthula Madhumehi person diet should be
Apatarpanaguna and heavy for digestion, while
Krisha Madhumehi persons diet should be
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Santarpanaguna and light for digestion. Krisha
patients diet should be such that it doesn’t
increase meda [7]. (3) Octafactor guidelines for
proper use of diet like Prakriti, Karan, Sanyoga,
Rashi, Desha, Kala, and the user, must be taken
into consideration [24]. (4) According to Ritu
(seasons), various diets and activities should be
prescribed depending upon the nature of prakriti
and doshas [25].
Pathya Ahara for diabetics in Ayurveda
Ayurveda has given utmost emphasis for the
maintenance of Pathya Ahara. Ayurveda stated
that if one take wholesome diet and activities
suitable to all Dhatus (tissues), he can never
suffer from Madhumeha [9]. It is said that, like
bird reaches its nest on the tree, in the same way
Prameha reaches the person who eats more,
unhygienic (even by not taking bath) and lazy
[9]. Quantity and quality of diet should be
decided on the basis of Agnibala (digestive
power). The recommended diet for Madhumehi
is detailed in Table 1 [7,26].
Table 1. Recommended Pathya Ahara for diabetics
(adapted after [7,26]).
Group
Name of items
Grains
Yava (barley)- Hordeum vulgare, Godhuma
(Wheat)- Triticum sativum, Shashtika Shali
(rice)- Oryza sativa, Kodrava (grain
variety)- Paspolum Scrobiculatum,
Uddalaka, Shyamaka, Bajara
Pulses
Chanaka (bengal gram)- Cicerarietinum,
Adhaki (toor dal)- Cajanus cajan, Mudga
(green gram)-Phaseolus aureus, Kulattha
(Horse gram)- Dolichos biflorus
Vegetables
(bitter and
astringent)
Methika (fenugreek)- Trigonella foenum,
Patola (pointed gourd)- Trisanthus dioica,
Karvellaka (bitter gourd)- Momordica
charantia, Tanduleyaka (Choulayee)-
Amaranthus spinosus, Vastukam (Bathuva),
Shobhanjana (drum stick)- Moringa
oleifera, Karkotaka – Momordica dioica,
Rasona (garlic)- Alium sativum, Kadali
(raw banana)- Musa paradisiaca.
Fruits
Jambu (Jamun)-Eugenia jambolana,
Talaphala- Borassus flabellifer, Amalaki
(goose berry)-Emblica officinalis, Kapittha
(monkey fruit)- Limonea acidissima,
Dadima (pomegranate) – Punica granatum,
Tinduka – Disospyros embrayoptesis.
Seeds
Methika, Kamala- Nelumbo nucifera,
Utpala – Nymphoea stellate,
Flesh (fat
free meat;
forest
animals,
forest
birds)
Harina (deer flesh), Shashaka (rabbit),
Birds likes –Kapota (pigeon), Titira,
Lavaka.
Fermented
or alcoholic
liquids
Madhveeka Sura, Madhvasava (in Kapha
Pittaja Prameha), Purana Sura- old wine
Other
natural
products
Madhu (honey), Madhudaka (honey mixed
with water)
Oils
Nikumba (Danti- Baliospernum montanum),
Ingudi (Balanitis egyptica), Atasi (Linum
usitatisimum), Sarshapa (Mustard)
Others food
articles and
spices
Dhani (pop corn of jowar), Laja/Murmura
(puffed rice), Maricha– (Piper nigrum),
Saindhava– (rock salt), Hingu- (asafoetida),
Haridra- (Turmeric), Ardraka- (Ginger)
The indigenous diet may not be useful in
lowering the blood sugar to the same extent as
insulin and other hypoglycemic agents.
However, by acting as Ayurvedic nutraceuticals,
it supplements and improves the quality of life;
therefore, may be useful as adjunct to manage
the disease and its complications. Ayurvedic
dietary plans comprise a wide range of
multivalent actions as health promoting dietary
additives as well as putative therapeutic agents,
which is of considerable importance to diabetic
health.
Contemporary supporting data
Researchers have proved that simple
carbohydrates are broken down easily and
increases blood glucose levels fast. Hence
simple sugars like table sugar, honey, candy,
jam, cakes and pastries etc. are contraindicated,
while complex carbohydrates like cereals, whole
grains, and vegetables are recommended at least
to 50% of diabetic diet. Another study suggest to
avoid high fat, salt, alcohol, caffeine and refined
(white) foods such as white sugar, white flour,
white bread, pastries, and so on. These have high
glycemic index (GI) and will cause the blood
sugar levels to spike [27].
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Ayurveda suggests increased intake of fiber
rich green vegetables and cereals (Patola,
Tanduleyakam, Vastukam, Yava, etc.). Yava
(barley) is high in fiber content (4 g in 100 g)
and is highly recommended in diabetic diet in
different forms. In a primary clinical trial in
normal subjects, blood sugar pattern was
recorded after giving different types of food such
as wheat chappati, barley chappati, bajra
chappati, maize chappati, gram chappati and
rice with Patola curry separately. Three blood
samples were taken at hourly intervals. The
maximum rise was recorded in rice, followed by
wheat while the minimum rise in the case of
Yava which surpasses all cereals and pulses.
Thus barley proved to be the best diet for
patients with Prameha [28].
Comparatively, whole green gram, bengal
gram have more fiber content (4 g) than green
gram dal and bengal gram dal (1 g). Whole horse
gram and Toor dal also have rich fiber content (5
g) [29]. Hordeum vulgare, Oryza sativa,
Triticum sativum, Green gram, Toor dal,
fenugreek, onion, garlic, gooseberry, Jamun etc.
are recommended to diabetics by modern
researchers too [30]. Of interest, many reports
proved the advantages of vegan diet for
reduction in diabetes incidence [31,32], its
ability to improve insulin resistance being well
established [33].
Honey is a sweet but highly nutritive natural
product. Is it beneficial or detrimental in
diabetes? Honey supplementation alone or in
combination with antidiabetic drugs has been
found to reduce hyperglycemia in rodents and
humans with diabetes mellitus. However, the
mechanisms of the hypoglycemic effect of honey
remain unclear. The possible roles of fructose,
mineral ions (such as zinc, copper and
vanadium), phenolic acids and flavonoids have
been suggested. The protection of the pancreatic
beta cells against oxidative stress and damage
(via honey antioxidant molecules such as organic
acids and phenolic compounds) is one such
potential mechanism [34,35]. This supports the
Ayurvedic recommendation to use it alone or
mixed with water in diabetes.
Role of fruits, vegetables, spices
and seeds in diabetes
Fruits, vegetables, and spices are
micronutrient rich; influence various systems in
the body with diverse metabolic and
physiological functions, and enable elderly
diabetics to be fit and active. They provide
nutritional substances like dietary fiber,
vitamins, minerals, phytonutrients such as
flavonoids (antioxidants), saponins, polyphenols
(antioxidants), carotenoids (vitamin A-like
componds), isothiocyanates (sulphur-containing
compounds) and so on, which are essential to
ensure a balanced diet. Type 2 diabetics can
enjoy fruits except those containing high
carbohydrate and sugar levels (i.e. avoid high GI
items). Avoid fruits with high GI like Banana,
Cheekoo, Grapes, and Mango etc. but Orange,
Watermelon, and Apple Guava etc. can be
advised. Although watermelon has a high GI, the
Glycemic Load (GL) per food serving is low and
it will not have a big effect on glucose levels.
Try to avoid fruit juices; instead opt for whole
fruits, as they contain more fiber and are more
filling. Consume cooked or uncooked vegetables
with little or no dressing. Opt for fat-free or low
fat dressings on salads, as well as uncooked
vegetables.
Spices are food adjuncts that have been used
as flavoring and coloring agents and as
preservatives. They are recognized to possess
medicinal properties too, and their therapeutic
role is highly appreciated in Ayurveda. They
exert several beneficial physiological effects
including some antidiabetic effects like short
term blood glucose decrease and long term
improved glucose tolerance. A number of
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condiments and spices advocated in Ayurveda
including pepper, asafetida, fenugreek seeds,
cumin seeds, curry leaves, ocimum, rock salt,
turmeric, cinnamon, mustard, garlic, onion,
ginger and coriander are reported to possess
potential antidiabetic substances and have been
ascribed hypoglycemic activities, both
experimentally and clinically.
Vegetable and fruit fibers reduce the risk of
diabetes, delay sugar digestion and absorption,
improve the insulin sensitivity and glucose
utilization and relieve constipation. Along with
rich fiber content, fruits contain considerable
amount of phytates, which modulate glycemia
and produce a different GI of foods. Phytates
affects the digestability of starch by combining
with protein or digestive enzymes. Chromium is
a critical cofactor in insulin action and its
deficiency can lead to hyperglycemia. Some
studies have reported benefits of chromium
supplementation for glycemic control in
diabetes. Trivalent chromium is found in whole
grains, seeds/nuts (almond, walnut), green beans,
cereals etc [36-39].
Conventional approach to diet therapy
Given the heterogeneous nature of type 2
diabetes, diversified diet with a judicious choice
from a variety of food groups is essential to
provide the necessary nutrients. However,
overeating should be avoided. Meal plans and
diet modifications are generally individualized
by a registered dietitian to meet patient needs
and lifestyle. A typical conventional approach
would recommend a diet composed of 60-65
percent carbohydrate, 25-35 percent fat, and
10-20 percent protein, with limited or no alcohol
consumption [40]. The dietary choices ought to
be practical, dynamic and flexible, based on the
prevailing situation. Food related approaches,
both in qualitative and quantitative terms, should
be well planned.
Diabetic meal plan
A diabetic meal plan matches calories from
foods to individual physical activity and insulin
levels. In a balanced diet, a wide variety of
selected vegetables, fruits, cereals, spices and
minimally processed foods would be expected to
help maintain the glycemic level and BMI within
limits and reduce the risk of a range of chronic
degenerative illnesses. WHO recommends intake
of whole grain foods, with a minimum
consumption of 5-10 portions of fruits and
vegetables per day [41,42]. A 1500 calories
Diabetic Diet chart suggested by the National
Institute of Nutrition, India, is detailed in Table 2
[43].
Table 2. 1500 calories diabetic diet chart
(Adapted after [43]).
Food stuff
Amount (g)
Vegetarian
Non-vegetarian
Cereals
225
250
Pulses
60
20
Green leafy
vegetables
200
200
Other vegetables
200
200
Fruits
100
100
Milk
300
150
Oil
15
20
Flesh foods
--
70
This diet provides
Grams
% calories
Protein
60
15.5
Fats
37
21.5
Carbohydrates
244
63.0
Lifestyle related etiologies
of diabetes in Ayurveda
Asayasukha (habituation to sitting on soft
cushions for long periods) and
Swapanasukha/Atinidra (prolonged sleeping) are
suggested as key predisposing factors for
diabetes [1]. Divasvapna (day sleeping) is also
one of the causes of Prameha [44,45]. Charaka
has also emphasized that anxiety, anger, worry,
grief, and similar other stress producing factors
lead to the development of Prameha in
susceptible individuals. Madyapana (alcohol
consumption) has a significant role in the
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etiology of Madhumeha [46]. Vyavayi, Vikasi
etc. ten Guna (properties) of Madya (alcohol) are
opposite to Ojas, causes Tridoshadushti
(vitiation) and Kshubdhata (altered state) in Ojas
[46] which in turn can hamper
Vyadhikshamatava (immunity); it may be one of
the predisposing factors of Madhumeha.
Contemporary supporting data
Machines have made us sluggish. In parallel
with lifestyle changes, walking habits have
changed, supported by the increased use of
automobiles and two wheelers. The prevalence
of type 2 diabetes is raising much more rapidly
because of sedentary lifestyle or reduced activity
levels [20,47]. A pathway through which obesity
causes insulin resistance has recently been
discovered in mice, in the form of an adipose
tissue derived hormone named resistin – an
important link between the adipocyte and
diabetes [47-49]. Hyperinsulinemia and insulin
resistance factors are insidious features of
obesity, having direct correlation with BMI [50].
Although BMI and physical activity are
independent predictors of incident diabetes and
mortality, the magnitude of the association with
BMI is much greater than with physical activity
[51].
Day napping and short night sleep are
reported as a potential risk factor for diabetes
[52]. Though much evidences are not available
on the role of Ratrijagarana (vigil) in diabetes
development, a report of the University of
Chicago Medical Center showed that sleep
deprivation severely affects the body ability to
metabolize glucose, which can lead to early
stage type 2 diabetes. It was observed that both
short-term (<6 h) and long term (>8 h) sleep, as
well as sleep loss, are related to glucose
intolerance and to increased risk of type 2
diabetes [53-55].
Stress related anxiety has been shown as a
major contribution factor for type 2 diabetes
[56]. Middle to old age is the common age group
of type 2 diabetics and this is the period in life in
which persons get exposed to a variety of stress.
Further stress causes imbalance in hormonal and
nervous regulation of the body and makes the
person susceptible to different disorders
including diabetes. A high risk of complications
of diabetes is associated with influence of
psycho-stressors and depressive disorders [57].
This is supported by a study wherein diabetes
was induced by stress in albino rats and their
blood examination showed increase rate of
catalase activity, suggesting the acceleration rate
of cell injury and free radical generation, which
in turn is a precursor to diabetes [58]. Addiction
may also adversely affect the diabetic health.
Tobacco chewing, smoking and alcoholism are
considered as risk factors for diabetes [59].
Pathya Vihara for diabetics in Ayurveda
For preventing Prameha, Sushruta has
recommended walking of 100 yojan in 100 days
i.e. 1 yojan per day (1 yojan is ~ 7.5 km) [10]. A
quotation ‘Nihsukhatva Sukhaya cha’ in
Kaphasya upakrama mentioned by Vagbhata is
very appropriate for preventing type 2 diabetes
[8], which means withdrawing of luxury to
create happiness. Sthula Pramehi are advised to
do exercises like wrestling, horse riding,
vigorous walking etc but Krisha Pramehi are
advised to protect their strength and not to do
exercises [7].
Contemporary scientific supporting data
A study reported that a daily brisk walk of
7.5 km (brisk is walking with speed of at least 5
km/hr) for 100 days can reverse Glucose
Tolerance Test to normal [60,61]. Lack of
exercise may be one of the main factors for the
bad glycemic control in chronic cases. Risk of
getting diabetes can be reduced by regular
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exercises and maintaining ideal body weight.
Physical activity has been shown to reduce
hyperinsulinemia and improve peripheral insulin
activity in 65 year old subjects [62], which
shows that even at this age, chronic diseases can
be fought through a better lifestyle. Exercise
improves insulin sensitivity and glucose
absorption, transport and uptake are increased in
perfused skeletal muscle, which reduces the
insulin requirement. Exercising also increases
blood flow through distal muscle groups
increasing oxygenation to tissues in the feet and
hands. Distal extremity blood flow is decreased
primarily in a stocking and glove pattern. This
increase in oxygenation lessens the chances of
tissue ischemia and neuropathy and increases
capillary blood flow. Aerobic exercise also
increases stroke volume and heart muscle
contractibility, thus increasing vascular
efficiency [63]. Though Ayurveda cautions
sedentary life styles as a factor for diabetes it
also cautions excessive starvation and excessive
exercises which may also lead to another variety
of Diabetes. This may be either Type-I or
Malnutrition Diabetes.
Earlier, exercise was considered as a major
tool to control diabetes to a certain extent and it
was recommended to each and every diabetic
patient. But as mentioned in Ayurveda, Krisha
Pramehi are suggested not to do high intensity
exercises and advised to protect their strength.
Similarly in type 1 diabetes, there are risks of
hypoglycemia during or after high exercises or
of worsening metabolic control if insulin
deficiency is present; therefore, well planned
exercises regimens are suggested for them [64].
Evidences from lifestyle intervention
RCTs and Meta-analyses
Recently conducted randomized control
trials and systematic reviews showed that
progression to type 2 diabetes in high risk
individuals can be prevented/delayed by
adopting a lifestyle intervention program
(increasing physical activity, dietary
modification, and weight loss). It reduced the
rate of conversion from Impaired Glucose
Tolerance (IGT) or pre-diabetes to type 2
diabetes [65-68]. Lifestyle intervention reduced
or delayed the risk of diabetes by ~ 60% over a
3-year period in people at high risk (IGT). These
interventions included intensive lifestyle
modifications, with goals of > 7% loss of body
weight and 150 minutes of physical activity per
week. Both emphasized restriction of energy,
lower fat intake, and higher fiber intake.
No exercise or less exercise may cause
insulin resistance and reduce glucose utilization
or insulin sensitivity. A recent meta-analysis
showed that exercise reduces HbA1c levels by
an amount that is expected to reduce diabetic
complications, without a mean effect on body
weight [69].
In the Nurses’ Health Study, the
combination of a high GL and a low cereal fiber
intake further increased the risk of diabetes
(relative risk = 2.5) when compared with a low
GL and high cereal fiber intake [70]. Refined
starch could be more important in this context
than refined sugars because, weight for weight,
starch yields twice as much glucose than
sucrose, and can be rapidly digested and
absorbed. Glycemic excursions appear to be
similar between starches and sucrose (table
sugar). White bread intake may be one of the
best single food predictors of type 2 diabetes
[71]. A stronger association has been observed
between total fat and saturated fat intake and
type 2 diabetes [72,73]. Intakes of both whole
grains [74,75] and dietary fiber (in particular,
cereal fiber) are associated with lower risk of
type 2 diabetes [76].
Need of society awareness and
self care strategies for diabetics
The rapid rise in the incidence of diabetes is
attributable to the social change. Initiation of
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prevention strategies to develop preventive
measures is strongly needed. Community
awareness is required to improve knowledge and
attitudes about the role of physical activity,
nutrition, and healthy eating behavior in disease
prevention. Increased community skills to
change behaviors and adopt a healthy lifestyle
through community-based interventions in a
variety of settings such as schools, worksites,
churches, community centers is needed.
Self-care coping strategies in patients with
diabetes are needed and these would be more
achievable if they are well aware and advised to
follow suitable dietary and lifestyle
recommendations mentioned in Ayurveda.
According to the literature, neither the curative
model nor the compliance/adherence model is
rigorously effective in diabetes care. An
alternative paradigm is needed that recognizes
the patient is in control of, and responsible for,
the daily self management of their diabetes.
Yoga provides an appropriate lifestyle
intervention that would be greatly helpful in
preventing or postponing the diabetes
prevalence. Significant physical, physiological,
psychological and endocrine changes have been
reported by following various Yoga regimens
(Asana, Pranayama etc) over a period of time. It
is also postulated that rejuvenation or
regeneration of beta cells of pancreas may be
taking place, which may increase utilization and
metabolism of glucose in peripheral tissues, liver
and adipose tissues through enzymatic processes.
It is effectively proven to improve quality of life
in diabetics and should be adopted in daily
routine [77-79].
Conclusion
Disorderly lifestyle plays an important role
in the development of type 2 diabetes. Along
with drug interventions, emphasis must be given
to socioeconomic, behavioral and nutritional
issues and to promote a healthier lifestyle (in
order to increase compliance to the lifestyle
modifications) especially for high risk
individuals. Dietary and lifestyle plans should be
made in accordance with the day-to-day
requirement of an individual. Due importance
must be given to adopt Yoga in daily routine.
Maintaining physical wellbeing, mental
tranquility and sanctity is equally crucial.
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