August 25, 2011

Let's Put our Heads Together: Suggest Diabetes-Friendly Foods for Indian and South Asian Vegetarians

Cutting carbs is quite easy for people eating meat-based western diets, and very effective for cutting carbs. But periodically I hear from people with diabetes diagnoses who for religious or cultural reasons can't eat the kinds of food we westerners do.

My usual suggestions are to eat more cheese, eggs (if allowed), nuts, yogurt, certain dals, papadums, green vegetables, lower carb fruits, and to chose beans over wheat and rice flour-based products. I warn people to avoid soy protein because of it's negative effect on the thyroid. Soy also, because it damages the inner lining of the intestine, makes it much more likely that large proteins from vegetable sources will get into the bloodstream and provoke allergies. (I'm convinced the current increase in gluten allergies we hear so much about of late is a byproduct of the soy that has been in our diet for a generation.)

I'm not sure what the availability is of protein powder in other countries, or if it is affordable. One of the big challenges of a lower carb diet is that all the cheaper foods most people in the world can afford are very high in starch.

So I'm asking for some other suggestions especially from anyone who has made a vegetarian diabetes diet work for more than a year. What are your ideas. Please post them in the comments section.

 

21 comments:

Peter said...

Before we make suggestions it would be good to understand why it is that south Indian vegetarians who eat mostly rice and vegetables have such extraordinary high rates of heart disease and diabetes compared to either north Indians who eat meat and wheat, or compared to American vegetarians who eat lots of rice and vegetables too.
The closest I've gotten to south India is Miami, so I don't have a clue what the problem is, but I've wondered for quite a while. I've read that the heart disease rate is 15 times north India, but don't know if that's really true, and I've read that maybe genetics, malnutrition, or cooking oils might have something to do with it.

Jenny said...

My guess is that the reason is the same that explains why so many other populations have had high rates of diabetes a generation after coming into a situation where there was more food available than in past centuries.

I found an old medical book from the 1920s that explained that adult onset diabetes was a disease mostly found in Russian Jewish immigrants. It wasn't their diet, it was the fact that they had been living on such a marginal food supply in Russia and found prosperity and food in America. Several generations later, that population isn't outstandingly diabetic.

But most people who are only a generation away from routine famine do seem very prone to be diabetic.

Andreboco said...

I have been working for the last 3 1/2 years with diabetics in India. 2 of them with Dr. Ron Rosedale. The middle class and affluent acount for a large portion of the new diabetics. They have abandoned their traditional use of ghee and coconut because they were told that fat is bad. When they dropped the fat they increased the sugar enormously. It is hard to get a steak in India that doesn't have a sugar glaze on it. It is like America in 1988.
Fat is bad, sugar is good,. On TV, commercials promote Glucon-D, a glucose mixture that people feed to themselves anf their animals. The traditional Hindu is vegetarian and doesn't eat enough protein. Now without fat they are only left with carbs to eat. To supplement with whey, Omega 3, even magnesium is difficult as the government regulates all supplements and it is hard to get good ones. As I think of more, I will add them. As always, I love your blog and your great work Jenny.

ravenrose said...

Good discussion.

I think the first thing to remember is that people can be quite robust on diets where FAT is the primary source of calories.

It's not too hard to create a healthy low carb diet without meat, even to emulate the flavors of South Indian cooking, but the portion sizes are going to be small because of the high fat content. You don't get that rice bulk.

Cauliflower is popular in India and that has a lot of potential. Cabbage can also be used as a "background" that replaces rice conceptually if not visually.

What is the availability of flax there?

For those who eat eggs, they should be a mainstay, of course.

Don't know if you say that Wikipedia says, "According to the 2006 Hindu-CNN-IBN State of the Nation Survey,[10] 31% of Indians are vegetarians, while another 9% consumes eggs. Among the various communities, vegetarianism was most common among Jains, Brahmins at 55%, and less frequent among Muslims (3%) and residents of coastal states. Other surveys cited by FAO[11] and USDA[12][13] estimate 20%–42% of the Indian population as being vegetarian. These surveys indicate that even Indians who do eat meat, do so infrequently, with less than 30% consuming it regularly, although the reasons are partially economical.[13]"

[http://en.wikipedia.org/wiki/Vegetarianism_by_country#India]

Jenny said...

Andrebocoand Ravenrose, Thanks for some very helpful ideas and statistics.

When we talk about dealing with diabetes worldwide the cost of protein becomes a huge issue, because that is what keeps so much of the world eating rice and grain. We can't forget that one reason that people eating "traditional" diets didn't develop blood sugar problems is that they were often on the edge of starvation and weren't getting enough starch in starch-heavy diets to raise blood sugar.

In my historical researches I've been struck by how little food most families even in Europe had to eat. The typical English worker in 1900 had one pound a week with which to pay rent, clothe and feed, an entire family, and with no birth control, families were large.

Near starvation did not make people healthy. During WWI the British army had to reject a huge number of male recruits because they could not meet the height requirement which was 5'4". I have read that eventually this was dropped to 5' as the need for manpower grew.

Venkat said...

Hi Jenny,

I am a south Asian / south Indian vegetarian (for religious reasons). I a Male, 40 years, Type 2 diabetic for the past 12 years. I follow low carb for the past 3 years (since May 2008) and maintain blood sugar under control. I live in the US...

I eat almond pancake in the morning - this requires 1 egg, almond, coconut / olive oil, cinnamon etc - ~ 600 calories

Lunch - steamed vegetables (no roots), cheese, Olive oil, nuts (macademia) - this ~ 800 calories.

Evening - I use vegetable (Lettuce / Cabbage / Egg plant/ radish) as a base, add a egg, 2 Tbsp of flaxseed, 2 Tbsp of extra virgin coconut oil etc and make it like Frittata. Once prepared, I add about 100-150 gms of cheese (costco) and keep it in Mwave oven for 30 seconds. This is ~ 600 calories...

I avoid 100% grains. 2 twice a day I drink "Starbucks regular coffee without creamer".

At first, the above food regimen appeared very alien for me. But after reading all prominent low-carb blogs including yours, this is what I identified as acceptable for me and now I like what I eat.

Weekly once I try to stay 24 hour fast (Friday noon thru Saturday noon) :-). No force on the earth now can move me away from low-carb (unless Science proves low-carb is wrong).

If you / someone want more information, I can provide. Please let me know.

Thanks

Venkat

Jenny said...

Venkat,

Thanks so much for your very helpful explanation. I'm really heartened by the response we are getting to this post!

JP Lafungga said...

After going low carb, my husband & I gave up a lot of our favourite Indian foods such as parathas and naans. Except for dosa/tosai, which is a pancake type made from fermented rice and mung bean flours. Our reasoning is that it is fermented, so less carb-y. My husband's blood sugar levels seem well-controlled. A similar food is idly, made from the same ingredients but steamed instead. Both dishes served with coconut chutney, mint sauce and a bit of curry. We are from South East asia btw, but Indian food is easily found.

DogwoodTree05 said...

"The middle class and affluent acount for a large portion of the new diabetics. "

I wonder if it is more accurate to say that the middle class and affluent account for a large portion of newly diagnosed diabetics getting regular treatment.

Rad Warrier said...

I am a south Indian vegetarian living in Canada and was diagnosed type 2 diabetic 6 years ago. I don't do low carbing but have reduced the carb content of my diet significantly compared to my pre-diagnosis days. I eat one third of the rice I used to eat before and compensate with increased amount of curries (cooked vegetables.) The curries are typically made of such vegetables as cabbage, cauliflower, beans of various varieties, egg plant, okra, tomatoes, carrots, leafy vegetables like spinach, swiss chard etc, various dals predominantly moong dal, all with a liberal amount of coconut. Cooking oil is our traditional coconut oil. When I eat chapatti, I eat just one (or two at the most.) Typical breakfast is 2 dosa, or iddli, or 2 slices of bread, with liberal amount of curry or coconut/avocado chutney (six was the typical number pre-diagnosis.) I eat all types of fruits. I eat nuts regularly -- almond, walnut, pecan, and cashew mostly. Take a good amount of yogurt.

I have not tried to reduce fat (i.e., coconut oil or ghee) and the fat consumption may be a little higher than pre-diagnosis days because of the increased consumption of curries (which are cooked in oil.)

In short, the trick is to reduce rice/chapatti or the other starchy main item and compensate with increased amounts of curries (which are essentially cooked vegetables.)

Regards,
Rad

Rad Warrier said...

Continuing my previous post, I think people in the western world or in south Asia, vegetarians or non-vegetarians, eat a lot more food than is really necessary. Post diagnosis, I have significantly reduced the total quantity of food. In the initial days I used to get a "not yet full" feeling but the body quickly got accustomed to the reduced quantity of food and now satiety returns with really half or less of the food I used to take.

My problem is when I go to India on vacation. If I don't eat as much as before, my sisters, in-laws, and other relatives would think that either I find the food tasteless (which is far from true because the food they cook is extremely tasty and I have to exert a lot of self control not to binge) or I am not well (which is also not true.) So, sometimes I give in and binge. I try to compensate by doing extra exercise like walking or jogging.

Regards,
Rad

Jenny said...

Rad,

You bring up a very important point. In many cultures, it is rude to refuse food. I was raised that way, and spent a summer living with a family in a foreign country where the culture was that food should be offered until the guest stopped eating. Since I'd been trained to eat everything I was served and leave the plate clean, things became very strained and I got to where I was terrified to approach a meal, fearing the mounds of food I'd be confronted with!

Someone eventually noticed what was happening and explained the cultural differences to me. But yes, the need not to offend by refusing food is a huge problem for many of us with diabetes.

Natalie said...

I'm confused by what you say about soy, because the Japanese, Chinese and Koreans have been eating it for millennia, and I don't THINK they have any excess of thyroid problems. Could it be that the PROCESSING of soy to form fake proteins is really the problem rather than soy itself?

Jenny said...

This is documented fully in the book, The Whole Soy Story by Dr. Kaayla Daniels. She documents very fully that those cultures generally used small amounts of soy fermented using techniques that made it safe that NO ONE in the east uses now.

It is mainstream medical knowledge that soy slows the thyroid, and has many other negative effects. It has also recently been disproven that soy compounds have any effect on menopausal symptoms.

The soy industry lies like crazy and promoted a lot of very weak research to establish soy as health food so they could offload the excess crop of a plant mostly grown for the plastics industry.

Unknown said...

hink this might be what you are looking for: a blog for Indian diabetic recipes
http://gitaskitchen.blogspot.com/2009/03/polenta-upma-and-award.html

Andreboco said...

DogwoodTree05 said...
"The middle class and affluent acount for a large portion of the new diabetics. "

I wonder if it is more accurate to say that the middle class and affluent account for a large portion of newly diagnosed diabetics getting regular treatment.

No, the answer is it is more prevalent in the upper and middle class. I work with both. The middle class have "closer to the ground " diet. More veggies, less refined carb. All throughout the cities you can see the poorer natives walking, mostly slender and active. The middle and rich ride in the back of cars with their diabetic bellies front and center. It is every where in India now. India is #1, China #2, America #3.

I just went to this..."unknown"...http://gitaskitchen.blogspot.com/2009/03/polenta-upma-and-award.html...not a good web for any diabetic. Loads of sugar recipes...sweets, bananas etc...typical "you can eat this too BS"...might as well check out the ADA's web while you are at it. Note "Sarcasm". Thank you Jenny for the platform, as always.

JQ said...

I have been a vegetarian since 1985 and low carbing since May 2009. I have dropped my HBA1C from 7.8% to 5.6% and seen a massive improvement in my general health, and I have lost over 20 kilos to date. It is great to see vegetarian diets beeing taken seriously.

Indian and Asian food has always been part of my staple diet and I have adapted many recipes that I used to make before I began to low carb. My diet leans towards Mediterranean and Asian foods – but there are so many different styles of cooking in every tradition.

I have found some excellent recipe books that have helped me develop a lot of new staples using almonds, paneer (an Indian cheese) or egg as protein sources.

I use a huge variety of vegetables and being able to source authentic, good quality spices is important to the taste of South Asian food. In the UK most high street supermarkets sell a good range of spices and almost all sell paneer. There is often more variety and better prices in Asian supermarkets.

I have had 2 of Madhur Jaffrey’s vegetarian recipe books (Asian Vegetarian and World Vegetarian) for many years. Many of the recipes in them can be adapted very easily to a low carb diet.

By testing I have found that many pulses don’t give me much of a spike and I regularly eat kidney beans, chick peas, haricot beans and butter beans – lentils tend to give me a bigger spike. The time of day I eat carbs is also important – I am most carb tolerant in the evening. Portion size is also important with pulses. There is a lot of advice that can be given to potential vegetarian low carbers.

Commercial vegetarian food relies heavily on starch and is created by people who are not vegetarian themselves, they simply wish to have a vegetarian option. People who are not vegetarian see this kind of food when they eat out and this influences what they think constitutes good vegetarian food. When I eat out, it is rarely for the exciting and imaginative vegetarian cuisine.

I own a lot of low carb vegetarian recipe books (almost all are out of print). The Celia Brooks Brown veggie recipe book is my favourite and has food that is creative, imaginative and very tasty – including some delicious Asian type recipes. This book has been a real inspiration to me in helping me to develop and adapt my own recipes.

Neris and India’s Idiot Proof Diet Cookbook has some lovely Asian inspired recipes, including an onion bhaji using ground almonds and eggs as a batter. The vegetarian recipes in this book are accompaniments, the main focus in on meat. The vegetable sections in most low carb cookery books have recipes that can easily be made in to a main meal.

I think it is easier to make that dietary shift if what you are eating looks and tastes familiar. Confidence in the low carb kitchen, even if you have only one pot, can be learned. If you can’t cook you will struggle to low carb in the long term, whatever you eat. If you can cook, you need to think about food differently. Basing a meal on a protein source and developing the rest of the meal around it has helped me to be a successful vegetarian low carber – this is skill that everyone who follows a low carb diet should have.

Food is at the heart of festivals and family celebrations. Overeating at these times isn’t a vegetarian thing, it is part of the human condition. I find it difficult to resist at these times because the starch fuels food cravings for me, combine that with the pressure not to cause offense by refusing food and you have a recipe for being seriously derailed!

Michael said...
This comment has been removed by the author.
Shekar said...

As a South Asian vegetarian, it is impossible to do low-carb with my lifestyle. Here's my background and reasons why I compromised with moderate carbohydrate diet a la the poster Rad above.

Background: I am a thin Type II (123 lbs at 5'7") because of poor genetics (my grandad decided to pass this to me rather than some ancestral property). By choice, I have been an active person all my life and hence have things under decent control.

My bloodwork: I do not have IFG (regularly fast in 90's or lower), and have excellent A1C's (in mid five's for over a year. I also have excellent lipids because of my active lifestyle (25 mpw hard running at 8-8.5 mph, road biking at 18-22 mph and weights 2X a week). However, I do have impaired glucose tolerance and my 1 hr peaks (especially at lunch and dinner are unreasonably high (180-200). I do tend to return to normal ~125 by 2 hrs but my 45 min-1 hr spikes were what bothered me.

I am on no medication whatsoever and was diagnosed at A1C of 6.5 and FBG of 108.

I tried low carb (eggs/cheese like a poster above) and I was completely spent even before I could start my evening runs!! I just could not breakdown protein/fat fast enough for my high intensity workouts and I felt my feet were chained to a heavy iron ball while running on low-carb with protein/fat as my fuel of choice.

I switched over to brown rice from white and my peaks were lower by 15-20 points.

I tried a new method to beat the spike. Since IGT invariably involves impairment of Phase I insulin response and my Phase II response was fairly good, I tried eating a 15-20g snack 30 minutes prior to lunch to kick off my insulin production and then eat a proper meal. Today my 1 hr peak was 156 with 50g rice-carbohydrates, 10 g other carbs and 15g protein. The experiment was fairly promising and I have to see if it continues to work.

The bottomline is that if you are fairly active vegetarian, it is tough to do low-carb and exercise hard!! I aldo had a discussion with Dr Sheri Colberg and she said I am doing everything right, so ignore the peak!!

Jaysyk said...

I recently went vegetarian (3months ago) and I am having a lot of trouble staying low-carb. I also find that I get really sleepy even after 100g of white rice (basmati).

It was so easy to low-carb when I was eating meat. But I had time to get used to it and develop a system and 2-3 meals that I could make and eat on a regular basis.

However, as a student and a horrible cook, I'm having trouble finding easy to make/cheap vegetarian meals.

This discussion has given me hope that at least its possible. I need to figure it out soon because I really don't like feeling tired and out of it as I do when I eat rice/grains etc.

Jenny said...

Becoming sleeping after eating a large serving of carbohydrate is almost always a sign that your blood sugar is going dangerously high.

Buy yourself a cheap blood sugar meter and measure your blood sugar after eating that rice and you may get a nasty surprise. If you don't have to be a vegetarian for religious reasons, a vegetarian diet can be extremely hard on your health.

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