Module on “Principles of Diet Planning in Diabetes Mellitus” By- Dr. Mangalagowri V Rao

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PRINCIPLES OF DIET PLANNING IN DIABETES MELLITUS

 

INTRODUCTION

न च आहार समं किंचित् भैषज्यमुपलभ्यते I

शक्यतेप्यन्न मात्रेण नरः कर्तुम् निरामयम् II K. S. Khi. 4/5

No medicine is equivalent to food, only food can make a person disease free. The timely intake of food in proper amount helps in kindling of Agni, that is responsible for the digestion, assimilation and metabolism in the body. The diet should be a righteous combination of different food groups like cereals, pulses, fruits, vegetables, dairy products, non-vegetarian food substances along with judicious combination of spices to induce flavour, enhance taste and stimulate the Agni. Diet and lifestyle are the key factors in causation and management of the diabetes mellitus. The diet management becomes successful only in presence of wide variety of healthy food preparations.

Acharya Kashyapa devotes an entire chapter for Bhajya Vidhi Vikalpa. In Ayurvedic classics food preparations like Odana, Manda, Peya, Vilepi,Yusha, Bhakta, Supa, Kalka etc. are mentioned.

These varieties should be chosen as per the requirements. Further, the menu should be designed in such a way that it is suitable and acceptable for present scenario. The food preparations advocated should be comprising of foods that are non-nourishing and heavy, with high hypoglycaemic index.

Consumption of diet rich in calories and fats like junk foods, bread, butter etc. aggravate the problems in diabetes.

Principles of diet in diabetes mellitus
स्थूलः प्रमेही बलवानिहैकः कृशस्तथैकः परिदुर्बलश्च| सम्बृंहणं तत्र कृशस्य कार्यं संशोधनं दोषबलाधिकस्य||१५|| Cha. Chi. 6/15

The Pramehi is of types i. e. strong obese and weak emaciated. The strong and obese Pramehi should be managed with Shodhana and weak emaciated Pramehi should be managed with nourishing therapy. Even though, this statement is with respect to treatment, similar principle should be adopted in dietary prescription. Because, Dosha vitiated are same.

Diet planning on Ayurvedic principles

In Ayurveda always the Pathya and Apathya are decided upon the factors that are vitiated and the way in which pathology has set in. Pathya ahara helps in breaking the pathogenesis.

Samprapti Vighatana

Dosha: Vatakaphahara

Dushya: Meda, Mamsa, Asra, Shukra, Ambu, Vasa, Lasika, Majja, Rasa, Oja

Mala: Mutra, Sveda

Agni: Jatharagni, Dhatvagi

Ama: Tajjanya

Srotas : Medo, mamsa, Rasa, Rakta, Majja, Ojas, Mutra, Sveda

Srotodushti Prakara: Atipravritti

Ahara Vidhi Vikalpa

The state of excellence of health is obtained by the intake of Satmya Ahara suitable for a particular individual and it should be pleasant or acceptable for his mind as per principles of Ayurveda. Always man needs variety in food be it in taste or form.

Even though Ayurveda advocates 2 meals per day, Acharya Sushruta himself mentions, if one feels hungry, he should take food at that time as hunger is an Adharaniya Vega. Further, present day life the food should be suitable for the fast life.

Factors to be considered during meal planning

  • Various forms of food
  • Ideal form of food suitable for an individual
  • Regional preferences
  • Continental styles
  • Individual preferences
  • Time preferences
  • Easy to preparation methods
  • Common availability of food item
  • Suitable to present day

Factors that enhance Agni

As per Ayurveda, in diabetes mellitus or Madhumeha, the Dhatvagni is deranged leading to improper metabolism and raise in blood sugar values. Hence, the basic aim is to rectify the Jatharagni as well as Dhatvagni. The prime factor is timely in take of food in adequate amounts to bring about proper nourishment at the same time reduce the aggravated Kapha and Meda.

नाभोजनेन कायाग्निर्दीप्यते नातिभोजनेन ।

यथा निरिन्धनो वन्हिरल्पो वातीन्धनाव्रतः ।। च.चि.१५/७८ ।।

The digestive fire does not get kindled by fasting or by taking excessive food, as absence of fuel extinguishes fire and excess fuel extinguishes mild fire. Hence, one has to take food having good qualities after analysing Dosha, Kala ie. time, season etc. factors in the morning and evening like Agnihotri.

Ideal time for intake of food

The ideal time for intake of food is after appearance of signs of digestion of food.

उद्गारशुद्धिरुत्सहो वेगोत्सर्गो यथोचितः ।

लघुता क्षुत्पिपासा च जीर्णाहारस्य लक्षणम् ॥ भा प्र पू ५/११९ ॥

One should have clear belching, enthusiasm, proper manifestation of natural urges; lightness of the body, hunger, thirst after previously ingested food gets digested.

Spices for kindling the Agni

When the foods are cooked using the optimum quantity of spices, they provide flavor, taste and bless the individual helps in kindling the Agni and bringing back health and promoting longevity with least amount of expenditure. As per the principles of Ayurveda, Dhatvagnimandya the most important etiological factor Santarpanajanya diseases is rectified by the spices. The spices with Ushna guna, Katu rasa, Katu Vipaka and Kaphavatahara properties help in Amapachana and Srotoshodhana also, resulting in prevention and cure.

As per researches the spices like turmeric, ginger, garlic, cloves, pepper, cinnamon etc. also prevent non-communicable diseases like dyslipidemia, obesity, diabetes mellitus, neurodegenerative, cardiovascular, pulmonary, metabolic, auto-immune and neoplasm etc. by reducing cholesterol, blood-pressure and inhibiting platelet aggregation, lipid peroxidation and antioxidant properties.

Vatakaphahara Ahara

The diet chosen should be Ruksha,Guru at the same time not very dry that it increases Vata.
In the preparations like Yava Roti, Bajra roti, Ragi Roti along with the sabji make a balance, because the cereals and millets are Kaphahara, Guru and Ruksha and method of preparation reduce the excessive rukshata and bring about a balance.

Prevention of metabolic disorders

गुरु चातर्पणं चेष्टं स्थूलानां कर्शनं प्रति| कृशानां बृंहणार्थं च लघु सन्तर्पणं च यत् ||Cha. Su. 21/20 ||

The adoption of basic rule of management of sthaulya and Karshya as mentioned by Acharya Charaka helps in prevention and management of metabolic disorders including diabetes mellitus.  Variety of tasty and healthy Koshambirs, made of raw sprouted pulses along with uncooked vegetables like cucumbers, tomatoes are Guru, rich in nutrients as per modern and have all rasas making it ideal for person suffering from Santarpanajanya Vikara. They bring about balance between calories and nutrients both on Ayurvedic and contemporary nutritional views. Further, the seasoning with spices and less amount of ghee or oil helps to reduce the Ama dosha produced due to the intake of raw vegetables and pulses. It also provides taste and helps in digestion and proper assimilation.

Different salads in diabetes
Methi Salad/ Mixed vegetable salad with sprouted mung and different salads as per reference and season can be used accordingly.

Methi salad

Finely chopped methi – 100 gm

Onion finely chopped- 2

Tomato finely chopped – 2

Lemon juice to taste

Salt to taste

Grated coconut for garnishing

Method

Mix 1-3, Add lemon juice and salt to taste and toss it in a bowl. Garnish with grated coconut and serve

Multiple Choice Questions

  1. Which of the following Dushya/ entity not involved in Prameha Roga as per Acharya Charaka
  2. Meda
  3. Rasa
  4. Asthi
  5. Lasika
  6. The Agni gets diminished by
  7. Abhojana
  8. Atibhojana
  9. Both a and b
  10. By intake of Lavana and Ardraka
  11. The addition of spices brings about
  12. Taste and flavour
  13. Proper digestion and assimilation of food
  14. Ama dosha
  15. Both a and b
  16. The derangement of ……………… Srotas is found in Prameha roga
  17. Meda
  18. Mamsa
  19. Rasa
  20. All the above
  21. According to Ayurveda, which of the following is best Pathya for a Diabetic patient
  22. Jaggery
  23. Butter
  24. Yava
  25. Curd
  26. Which of the following drug is ideal for a Diabetic patient?
  27. Nisha- amalaki
  28. Jaggery with Kapikacchu
  29. Shatavari gudam
  30. chyavanaprasha
  31. Which of the following is not mentioned under the causative factors for Prameha roga?
  32. Sugarcane product
  33. Old barley
  34. Fresh/ newly harvested cereals
  35. Day sleep
  36. Which type of Prameha can be considered as Diabetes mellitus type 2
  37. Madhumeha
  38. Alala Meha
  39. Hasti Meha
  40. Shukra Meha
  41. The following has to be done for a Sthula Pramehi
  42. Samshodhana
  43. Brimhana
  44. Exercise
  45. Both a and b
  46. Laghu Santarpana chikitsa should be done in …………………
  47. Sthula individual
  48. Krisha individual
  49. Both a and b
  50. None of the above

Answer Keys

  1. C
  2. C
  3. D
  4. D
  5. C
  6. A
  7. B
  8. A
  9. D
  10. B

Links for further reading

  1. https://pubmed.ncbi.nlm.nih.gov/27664636/, Spices in the management of diabetes mellitus
  2. https://pubmed.ncbi.nlm.nih.gov/16361181/, Plant foods in the management of diabetes mellitus: spices as beneficial antidiabetic food adjuncts
  3. https://pubmed.ncbi.nlm.nih.gov/3075947/, Free radicals and diabetes
  4. https://pubmed.ncbi.nlm.nih.gov/14727499/, Ayurveda for diabetes mellitus: a review of the biomedical literature
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335207/, A contemporary scientific support on role of ancient ayurvedic diet and concepts in diabetes mellitus (madhumeha)
  6. https://pubmed.ncbi.nlm.nih.gov/21649515/, Prameha in Ayurveda: correlation with obesity, metabolic syndrome, and diabetes mellitus. Part 1-etiology, classification, and pathogenesis
  7. https://pubmed.ncbi.nlm.nih.gov/21668351/, Prameha in Ayurveda: correlation with obesity, metabolic syndrome, and diabetes mellitus. Part 2–management of Prameha
  8. https://pubmed.ncbi.nlm.nih.gov/30969135/, Characterisation of several types of millets as functional food ingredients
  9. https://pubmed.ncbi.nlm.nih.gov/28361824/, Postprandial glycaemic response of foxtail millet dosain comparison to a rice dosa in patients with type 2 diabetes
  10. https://pubmed.ncbi.nlm.nih.gov/20877753/, Dietary management in diabetes

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