In a few days the country will be celebrating the National New Year, with preparations already underway in hundreds of homes eager to serve their guests and families a New Year feast of traditional sweetmeats.
Come New Year, many persons including diabetics are likely to forget their usual recommended diets and feel tempted to indulge in consuming too much rich, high carbs sugary foods which can lead to a surge in their blood sugar levels, and undermine their already compromised health.
The Sunday Observer spoke to Professor in Medicine and Head, Department of Clinical Medicine, University of Colombo, Consultant Endocrinologist and Diabetologist, National Hospital of Sri Lanka Vidya Jyothi Prof. Prasad Katulanda to find out what foods should be avoided or taken in limited quantities and the healthiest methods of cooking traditional sweetmeats to minimise diabetes risks.
Excerpts
Q. In a couple of days, the National New year will dawn on us. As we celebrate this harvest festival amid a Covid-19 pandemic, health officials are concerned that the tendency to indulge in excessive consumption of rich sugar and oil laden foods, even by patients on prescribed diets at this time around, could lead to a surge in non-communicable diseases. As Diabetes is a leading non communicable disease tell us how common it is in Sri Lanka?
A. In Sri Lanka diabetes was shown to affect one in 10 adults 15 years ago. Although we don’t have a comprehensive countrywide study, a study done in Colombo district showed that diabetes among adults has nearly doubled in Colombo district. Therefore if we take a conservative estimate I feel that one in every seven adults in Sri Lanka may have diabetes as of now.
Q. Is there a rise in the number of Lankan diabetics in recent years? If so, in which districts? Why?
A. We have had a rapid rise of diabetes in recent years especially in more urbanised areas like Western Province, South and Jaffna but the increase is seen all over the island. The reason for this increase is that people have not changed their eating patterns to match their sedentary lifestyles. Sedentary lifestyles as you know are due to increased use of motorised transport even to travel a short distance like three wheelers and cars. Using machines for all purposes like even washing clothes.
Q. Are there different types of diabetes? Which of them are most common in Sri Lanka?
A. There are several types of diabetes. The commonest type in Sri Lanka and in the world is Type 2 diabetes. This is associated with lifestyle and common among adults, but there is a worrying trend among children as well. Type 1 diabetes is more common among children and especially in the northern hemisphere of the world, but we do see Type 1 in our country as well. The diabetes which appears first during pregnancy is called gestational diabetes and this is a risk factor for future Type 2 diabetes.
Q. Agewise and gender wise - who are the most vulnerable groups? Why?
A. Both males and females are affected with diabetes almost equally. Some time ago mostly older adults got affected due to diabetes, but we see a worrying trend of increasing diabetes among young adults and middle aged. This is a bad trend as many people in the society would live with diabetes and also the society would be burdened with many people with diabetes and its complications.
Q. Younger patients are being treated for diabetes. What are the main causes ? Unhealthy eating habits ?Too many sugary drinks and high carb diets?
A. Younger people are getting diabetes due to multiple reasons. Firstly there is increasing sedentariness (lack of physical exercise) is seen in modern day youngsters. Ideally a child or young adult should have more than one hour of physical exercise daily on average. In addition, they eat a lot of starchy food as well as sugar rich foods and beverages, which leads to high incidence of early diabetes .
Q. Is Diabetes curable? Can a newly diagnosed patient be cured?
A. Diabetes is considered not curable, but controllable. However, research has shown that newly diagnosed Type 2 diabetes can be reversed and controlled without medications with very strict diet control and exercises. We call this diabetes remission. One needs to lose a significant amount of body weight for this to be successful and this method is being practised now in Sri Lanka.
Q. How does diabetes affect our health in general?
A. Diabetes if not controlled can affect small blood vessels (micro vascular complications) and can damage our kidneys (nephropathy), nerves (neuropathy) and eyes (retinopathy). By these complications one can get kidney failure, nerve dysfunction and blindness. Nerve dysfunction can affect sensation of our feet, can get neuropathic pain and get other neurological issues such as sexual dysfunctions. Sexual dysfunction can happen due to lack of blood supply as well.
The commonest manifestation in this is erectile dysfunction which has become a big social problem. The neuropathy and lack of blood supply to our legs can lead to ulcers and foot amputation.
Diabetes if not controlled and if associated with high cholesterol can cause blocks in our larger blood vessels (macrovascular complications) and this can result in heart attacks, strokes and peripheral vascular disease.
Q. Since we are about to celebrate the New Year in a few days let’s talk about food and popular myths surrounding them. Although we have plenty of local fruits in our country, many diabetics are reluctant to eat them believing they have too much sugar and starch. To give you some examples, pumpkin, ash plantain, carrots, yams, jak fruit, coconut, certain types of banana, pineapple and papaw. What is your opinion on this?
A. There are fruits and vegetables which are generally more carbohydrate and calorie rich. Examples are pumpkin, ash plantain, yams, jak fruit, mangoes, banana and pineapple. While fruits have vitamins and anti oxidents if you take too much and if diabetic people do not account that to their overall calorie intake, they can get obese as well as their diabetes control can get affected. Therefore, not taking too much as well as balancing with other carbohydrates like rice and starch would enable them to take some amount of these fruits.
Q. What about sweetened drinks or fizzy drinks?
A. Fizzy drinks containing sugar are really bad for diabetes. While drinks like ambarella and nelli without sugar don’t contain much sugar most other fruit juices have sugar even without you adding it. If you do take them, eat them without making them into a juice as it is less harmful.
Q. Water? Tea? Milk? Which is better, especially for diabetics and children?
A. Taking plenty of water is very good for anyone and especially for those with diabetes it has many health benefits. Tea and milk without sugar is also good. Too much milk especially if you are not a very active person can make you fat.
Q. Let’s talk about traditional new year foods that adorn a festive table . Since butter cake, Kawum, kokis and mung kawum ,murukku murukku are generally a must on a new year table,are there ideal portions that even diabetics or those on the borderline can consume? Or should they refrain from these foods altogether?
A. Everyone likes to have some traditional sweets and foods you mentioned during the festive season. However, they have a lot of sugar, salt and oil. Therefore, if your sugar is high, you have high blood pressure and are obese you need to be very careful.
A practical method is not to have all types of these together at the same time but distribute them during the new year day or two. Also, you may eat a small piece of a sweet like a Kavum, but not the whole Kavum if you have diabetes or are obese. Another thing that we can do is to limit our other carbs like rice and starch foods during the New Year period if you want to enjoy a traditional sweet or two. In addition, leading an active life like doing walks and engaging in traditional games would minimize the harms of eating more during the New Year as exercise burns the sugar and calories.
Q. As most traditional New Year sweetmeats absorb a lot of oil during cooking and frying, what oil is best to use and how should they be cooked?
A. Among the oils unsaturated fats and oils are better for health. However, some oils may not be appropriate for the proper taste of some traditional food like Kevum.
Q. Cooking methods - Fried foods? Steamed foods? Or food cooked on the kitchen stove? Which is best?
A. Generally when we take food we take different types of food. We Sri Lankans take a lot of cooked food and fried food. We need to reduce adding oil into food and limit fried food. It may be a good habit to reduce the amount of coconut milk in food which will make us obese. We need to increase fresh salads and food as well as green vegetables and that would enable more vitamins and micronutrients to be made available in food. Lightly steamed food also would be better than thoroughly cooked food.
Q. What about traditional foods that don’t use much oil for their preparation such as kiribath ( milk rice) halapa, gotupittu, lavaria, dosia, aluwa aluwa aggala, rice talapa or payasam?
A. But all these foods have high amounts of carbohydrates, sugar and fats and should be consumed in limited amounts especially if you have diabetes, obese or has risk of diabetes (family history of diabetes).
Q. Today drinking beer, arrack, toddy or wine too has become a part of the New Year celebration. How good are they for those with Diabetic risks?
A. Alcohol is generally associated with many health risks. In addition to liver problems, high blood pressure and stroke using alcohol may predispose people for injuries and use of alcohol cannot be recommended and should be stopped or minimised as much as possible. Alcohol in excess causes the blood glucose to rise in diabetic individuals.
Q. Your advice to all New Year revellers who want to enjoy a diabetes free festive season?
A. Traditionally the New Year is a season where everyone has fun. In this modern day where there are many living with diabetes and non-communicable diseases, you need to be conscious of your health, while enjoying the festive season. Careful planning of meals and being mindful about what you are eating so that you don’t over eat, taking your prescribed tablets if you are diabetic, will enable you to enjoy a happy and healthy New Year.