Module on “Ahara Kalpana in Diabetes Mellitus” By- Dr. Mangalagowri V Rao

AHARA KALPANAS IN DIABETES MELLITUS

Introduction

 In any diet planning different food items that are wholesome for an individual should be incorporated. In diabetes mellitus, variety of cuisines can be incorporated based on the region, seasonal factor, personal choice and convenience. The dietary choices include, main course, side dishes, adjuvants, drinks etc. to provide a variety in the menu. Advocating wholesome contemporary and traditional diet items, rather than semi solid classical food items would enhance the chances of continuation of diet suggestions and positive impact of over all health conditions.

Pathya adjuvants for diabetes

Amla Chatney (Indian goose berry dip)

Ingredients: 8 amla- chopped, 5-6 garlic cloves- chopped, ½ tsp turmeric, 2 pinch black pepper powder, Coriander leaves- – chopped, Green chilli- chopped to taste, Salt to taste

Method of preparation: Put above said ingredients, in a mixer and blend it well, and amla chutney is ready to serve.

Benefits: This chutney is wholesome combination of Amalaki, a food substance advocated for regular intake by Acharya Charaka, good Rasayana, pramehahara in property, as per modern also it is very rich source of vitamin C and antioxidants, garlic is Kaphamedohara, srotoshodhaka, Agnivardhaka, black pepper is pramathi in nature and prevents obstruction of channels along with providing flavour, coriander provides flavour and pittahara.

Garlic chutney (dry)

Ingredients: Garlic cloves- 30, Curry leaves – 6 sticks, Dry coconut – ½ cup, Dry Roast a bit

Red chilli powder- 1 tsp, Amchur powder- ½ tsp, Salt to taste

Method of preparation: Lightly dry roast above said ingredients on mild fire, and put above said ingredients in a mixer and blend it well.

Benefits: Garlic is Kaphavatamedohara, Rasayana, also has hypoglycemic property and prevents atherosclerosis. The chutney is suitable for busy life of present scenario, as it can be preserved for 15-20 days.

Flax seed chutney

Ingredients: ½ cup flax seed, ½ cup chana dal, ½ cup grated dry coconut, 10-12 red chilly, Amchur powder to taste, Asfoetida- 1 pinch, Salt to taste

Method of preparation: Dry roast ingredients 1 and 2seperately, take 3 tsp of oil add 1tsp of mustard and 2 tsp of cumin seeds, when they sizzle add red chilli and grated coconut for a while. When they return to room temperature make it into powder.

Benefits: The flax seed has omega 3 fatty acids, which is beneficial. They contain lignans and antioxidants that help to prevent many complications due to diabetes mellitus. As per Aurveda it is Vatashamaka and Rakta, Shukra vardhaka. Hence, it is good for madhumehi.

Pathya main course choices for diabetics

The sources of carbohydrates like barley, finger millet, Italian millet, bajra, jwar etc. are Pathya for diabetes. They are Kaphahara in nature and provide energy. Even though many of them are Vatakara, by the proper samskara in the form of seasoning with ghee or oil and addition of water during cooking, being about balance of Vata and make the dish Pathya for diabetic. As per modern these items are rich in complex carbohydrates and thus help to regulate metabolism in the body. Further, they are rich in dietary fibres, thus helpful in the metabolic disorders like diabetes mellitus, which can be categorized under Santarpanajanya vikaras in Ayurveda. The cereals and millets can be used in different suitable forms like roti, daliya, upama, dosa, idli, dhokla etc.

Barley preparations

Roti/Khichdi/Daliya/Upama/Dosa/Idli/Pulihara etc. can be prepared based on personal choices.

Barley pulihara

Ingredients: 1 cup Barley Pearl, 1 tbsp Bengal gram dal, 1 tbsp black gram dal, 1 tsps Mustard Seeds, 2-3 Chilies Green, 1 Ginger ” piece and finely grated, 2 tbsps Peanuts, ½ tsp Turmeric, ¼ tsp Asafoetida / Hing, black pepper powder 2 pinches, 8 ~ 10 Curry leaves, Salt as per taste, Amla paste 3 tsp

Method of cooking

Combine barley, pinch of turmeric, salt and 2 ½ cups of water in a cooker/saucepan, cook it well till 2-3 whistles. Set aside until ready to use. Heat 2 tbsp oil in a sauce pan, add Bengal gram dal, black gram dal, ground nuts and mustard seeds. Once the mustard seeds begin to crackle, add 2 pinches of asafoetida, 8-10 curry leaves and green chilies. Add the seasoning to the cooked barley and season with salt. Add amla and pepper paste and mix well to combine. Garnish with grated coconut and serve warm or at room temperature.

Similar process can be adopted with wheat daliya also.

Regional food options

• South Indian breakfast items like Ragi Dosa/Ragi idli/Ragi balls/Ragi roti
• Green gram Dosa/Idli
• Bajra roti/Bajra Kichri/Jowar roti
• Similarly, Kanguni (Italian millet) roti/ upama/Daliya/Kichri

These can be included in meals based on preference along with adjuvants like Garlic Chutney/Amla chutney/Pudina chutney/curry leaves chutney and curries of different seasonal vegetables.

Curries in diabetes
Curries of Amla/Parwal/Kundru/ Bittergourd/Ash gourd are Pathya when prepared with less amount of oil and optimum quantity of spices.

Soups in diabetes

Green gram soup/Red gram soup/ Masur Dal (lentil) soup provide nourishment along with taste.

Masura Yusha (Lentil soup)

Ingredients: Lentils 2 cup- soaked in water for 1 hour, Tomatoes chopped- 3, Onions chopped – 1 big, Garlic- 4-5 cloves, Ginger – 5g, Turmeric ¼ tsp, Green chillies – 2, Mustard-1/2 tsp, Cumin seeds- 1 tsp, Garam masala- 1tsp, Salt to taste, Ground nut/mustard oil- 4 tsp for seasoning.

Method of cooking: The lentils are boiled in cooker for 3-4 whistles, ingredients 2-7 blended in a mixer. About 4 tsp of groundnut/mustard oil is taken in a sauce pan and seasoned with 1/2 tsp of mustard, 1 tsp cumin seeds when they spurt to that the blended mixture is added, when it is cooked add 1tsp of Garam masala. Now already boiled lentils are added and water added to get the consistency and salt added to taste. It is boiled for 5 minutes to get soup. Garnish with finely chopped coriander.

Buttermilk preparations
Butter milk is Pathya in diabetes as it is devoid of fat.

• Methi butter milk/Amla buttermilk prepared by adding paste of methi/amla with grated coconut to chutney followed by seasoning with curry leaves, jeera and mustard
• Seasoned butter milk with powder of combination of fenugreek seeds, cumin seeds and Carrum seeds in the ratio 2 : 1: 0.5
• Ginger, garlic coriander paste mixed with butter milk

Drinks

• Khadira sadhita jala/Madhudaka/padmaka sadhita Jala to pacify the thirst in daibetic
• Milk preparations to enhance nourishment with different adjuvants to pacify Kapha
• Milk with Haridra/Milk with Ragi malt/Milk with 2 pinches of pepper along with ½ tea spoon turmeric
• Vrikshamla ushna peya / Cocum drink: Cocum fruits (dried) 2-3 are kept soaked in 500 ml of water for about an hour, then it is boiled well for 10 minutes, so that the active principles are extracted well. Then seasoning is done with ground nut oil by adding cumin, mustard, garlic and pepper. Salt is added according to the taste.

Discussion

The food preparations should be so that they are devoid of excessive kleda, sneha, should be Kashaya, Tikta in Rasa so that the ten Dushyas in Madhumeha can be pacified. Simultaneously they should be tasty and acceptable for present day lifestyle and requirements. The preparations like Yava roti, Yava Daliya, Yava Upama, Bajra Roti, Ragi Dosa, Ragi Roti, Mudga soup, sprouted green gram salad, Methi salad, Ragi malt, Milk with turmeric, Amalaki Chatni, Methi powder with rice and buttermilk, Garlic buttermilk, curry leave, ground nut chutney, Bitter gourd curry, Kovai curry, etc. are highly beneficial in the management of diabetes mellitus. These food preparations are Pathya as per Ayurvedic principles and are healthy with high hypoglycemic index at the same time rich in antioxidants thus help in management as well as prevention of complications of diabetes. The cereals and millets advocated as Pathya contain complex carbohydrates, and have high hypoglycaemic index, at the same time rich in antioxidants, thus help in management as well as prevention of complications. Vegetable oils like sesame oil in small amounts helps to give taste. Further the fresh vegetables and fruits that are rich in vitamins, minerals and antioxidants help to prevent complications like atherosclerosis etc. They are Rasayanas as per Ayurveda. Ginger extract consumption reduces plasma cholesterol, inhibits LDL oxidation, and attenuates development of atherosclerosis in atherosclerotic, apolipoprotein E-deficient mice. Ginger reduces hyperglycemia-evoked gastric dysarrhythmias in healthy humans: possible role of endogenous prostaglandins. Multiple mechanisms are involved in 6-gingerol-induced cell growth arrest and apoptosis in human colorectal cancer cells. Studies in Montreal and Tokyo in1955 and 1979 concluded that ginger also enhances immunity. Saindhava Lavana enhances taste. Rock salt is a source of minerals essential for our body. Satt promotes water absorption, maintains pH and helps in the movement of nutrients from tissue fluid and cells. In our Samhitas at-most importance is always given for Mitahara (restricted diet). Certain scientific studies on rodants reveal that restricted diet have the effect of reduction in weight, blood pressure, total serum cholesterol, leukocyte count, fasting glucose, and triglyceride levels

Similarly, a study conducted by National Institute on Aging (NIA) in a research project CALERIE (Comprehensive Assessment of Long-Term Effects of Reducing Calorie Intake) showed in the first phase that 25% Calorie Restriction with or without exercise reduced cardiovascular disease risk. It also showed a reduction in DNA damage and conserved the calcium intake. It shows that there is no adverse effect on bone health. This shows that certainly Mitahara as advocated by Aharyas benefits all the individuals. The spices with Ushna guna, Katu rasa, Katu Vipaka and Kaphavatahara properties help in Amapachana and Srotoshodhana, thuss beneficial in management of diabetes and also preventing complications. The modern researches also show that, spices act by reducing cholesterol, blood-pressure and inhibiting platelet aggregation, lipid peroxidation and antioxidant properties. Thus, on the whole all these factors combined with following various regulations of food as mentioned in classics of Ayurveda help in modulation of Agni and prevention of metabolic disorders.

Conclusion

Thus, on the whole all these factors combined with following various regulations of food as mentioned in classics of Ayurveda help in modulation of Agni management of Diabetes mellitus and also prevention of metabolic disorders. Pathya is not mere restriction of foods, but providing of variety of conducive food according to ones taste, culture and requirement. Variety food does not mean to consume it in excess, always food should be consumed in moderate quantity.

हिताशीस्यान्मिताशीस्यात्कालभोजीजितेन्द्रियः| पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||Cha. Ni. 6/11||

One should consume wholesome food in moderate quantity, at proper time with control over senses. Because most of the diseases difficult to cure are produced due to eating food at irregular intervals in improper quantity.

Multiple choice questions

1. Which of the following will be best suited for a diabetic patient?
2. Methika (Trigonella foenum- graecum)
3. Sweetened milk
4. Potato
5. Banana
6. Which milk product is most beneficial for a diabetic patient?
7. Curd
8. Cream
9. Butter milk
10. Cheese
11. Garlic is Pathya in diabetes mellitus, because it is………………….
12. Kaphamedohara
13. Vatahara
14. Rasayana
15. All the above
16. As per Acharya Charaka, which is the best option for a Pramehi
17. Oats
18. wheat
19. Barley
20. Rice
21. Which of the following peya is good for a diabetic patient?
22. Vrikshamla peya
23. Kharjuradi Mantha
24. Amra Panaka
25. None of the above
26. Which of the following is suitable drink for a diabetic patient?
27. Ushnodaka (Luke warm water)
28. Sheetodaka (cold water)
29. Lupsika
30. All the above
31. Which of the following will be good for a diabetic patient?
32. Amla murabba
33. Amla juice with turmeric
34. Amla pickle
35. Amla candy
36. Which of the following is Pathya for diabetic?
37. Barley pakoda with pudina chutney
38. Barley kheer
39. Barley roti with Dal methi
40. All the above
41. Barley is beneficial for diabetics because it is ………………………
42. Complex carbohydrate
43. Has high hypoglycaemic index
44. Has low hypoglycaemic index
45. Both a and b
46. Which of the combination is not indicated for diabetics?
47. Butter milk with fenugreek, cumin seeds and Carrum seed powder
48. Milk with sugar candy
49. Amla juice with turmeric powder
50. All the above

Answer Key

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

Links for further reading

1. https://pubmed.ncbi.nlm.nih.gov/27364038/, Effect of Amalaki rasayana on DNA damage and repair in randomized aged human individuals
2. https://pubmed.ncbi.nlm.nih.gov/31831963/, Effect of Ayurveda intervention, lifestyle modification and Yogain prediabetic and type 2 diabetes under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)-AYUSH integration project
3. https://pubmed.ncbi.nlm.nih.gov/28819266/, Amalaki rasayana, a traditional Indian drug enhances cardiac mitochondrial and contractile functions and improves cardiac function in rats with hypertrophy
4. https://pubmed.ncbi.nlm.nih.gov/30049636/, The effect of garlic on lipid profile and glucose parameters in diabetic patients: A systematic review and meta-analysis
5. https://pubmed.ncbi.nlm.nih.gov/23270395/, Garlic as an anti-diabetic agent: recent progress and patent reviews
6. https://pubmed.ncbi.nlm.nih.gov/25883426/, Efficacy of Turmeric as Adjuvant Therapy in Type 2 Diabetic Patients
7. https://pubmed.ncbi.nlm.nih.gov/12602929/, Effect of consumption of finger millet on hyperglycemia in non-insulin dependent diabetes mellitus (NIDDM) subjects
8. https://pubmed.ncbi.nlm.nih.gov/29222884/, Development and evaluation of nutritional, sensory and glycemic properties of finger millet (Eleusine coracana L.) based food products
9. https://www.researchgate.net/publication/322267725_ROLE_OF_YAVA_BARLEY_BASED_DIET_AND_YOGIC_PRACTICES_IN_MANAGEMENT_OF_MADHUMEHA_DIABETES_MELLITUS
10. https://pubmed.ncbi.nlm.nih.gov/30428550/, Possible Prevention of Diabetes with a Gluten-Free Diet