LIFESTYLE MODIFICATIONS: Key Pillars Of Diabetes and other Noncommunicable Disease Management

Dr. Vina Bang
MBBS, MD (Medicine), Consultant Physician, Orange City Hospital and Research Centre, Nagpur

As we all know the incidence of diabetes is increasing day by day. The disease is coming early,the disease is coming with complications at onset, the disease is coming with other comorbidities like hypertension, cardiovascular diseases,cerebrovascular diseases,fatty liver/NASH, obesity and dyslipidemia. So we need to focus on our change in lifestyle.Previously during 1960 incidence of diabetes and other noncommunicable diseases was too low as people were physically very active, having less stressful life and used to eat healthy low calorie diet but now our lifestyle has changed a lot.We have a sedentary lifestyle, less of physical activity, mental stress has increased and we are eating high calorie diet(high carbohydrate and high fat). We tend to focus only on “Medicine” part, other pillars are being neglected by both patients as well as doctors.So it is the need of time to understand this and cut on this problem by changing our lifestyle. We need to accept some modifications in our present lifestyle

Lifestyle modifications include

  1. Healthy diet
  2. Physical activity
  3. Reducing mental stress

These are the three important pillars in the treatment of diabetes and other noncommunicable diseases management along with medicines.

  1. Healthy diet

Diet is one of the most important pillar in treating diabetes and other noncommunicable diseases. We should have low-calorie diet means low carbohydrate and low fat and replacing it with protein. We should take the appropriate amount of calories which differ from person to person according to his/her ideal body weight. Once calories are been calculated,its distribution is also important.

Calories should be distributed in 24hrs meal as below

    • Breakfast: 25% calories
    • Lunch: 25% calories
    • Dinner: 25% calories
    • Remaining 25% should come from 3 light snacks.

Carbohydrates
It should provide upto 50 to 60 percent of total calories. Avoid simple carbohydrates like cane sugar, honey,jaggery,sweets ,maida.Include more cereals,mixed coarse grains,whole pulses and salads.We should choose food items with low glycemic index like apple,green leafy vegetables,mosambi,brown rice,jowar.Avoid high glycemic index foods like potato,rice,sugar, corn,banana and other sweet fruits.

Protein
It should provide upto 15to 20 percent of calories.It causes early satiety so patient feels full early. We should include egg white, pulses,daals,soyabean,Ragi,panner,tofu in our diet as a good source of protein.

Fat
It should provide upto 30 percent of calories.Saturated fats should be less than 10 percent which include dalda,coconut oil and same oil used for multiple cooking. More the saturated fat (transfat) more is the risk for heart diseases. We should try to decrease use of oil to minimum and we should avoid eating deep fried items.
Recommended oil intake 15 to 20ml(3 to 4tsf)per day
No oil is perfect amongst oils available in market. So change of oils is advisable to have all micronutrients in appropriate amount.

Salt
Should be upto 5gm per day.Amount should be reduced in patients with hypertension and kidney diseases.We should try to use Himalayan rock salt(sendhe namak)in place of routine salt.Potassium content should also be adequate in the salt.

Fruits
Those who are diabetics should eat low calorie fruits like apple,papaya,guava,mosambi,jamun.Avoid sweet fruits like banana,mango,chikoo.

Alcohol
Should be reduced in terms of frequency and amount as it worsens diabetic control and increases risk of hypoglycemia. Need to decrease any form of tobacco and ciggarete or bidi smoking as tobacco constricts the blood vessels.

Green leafy vegetables
Should be included in diet as it regulates blood pressure.Green leafy vegetables are rich source of iron.

How to reduce cholesterol
-By eating low fat,low calorie and high protein diet and decreasing saturated fat content in diet
-By increasing fibers in diet
-By reducing weight

Now the question is ‘How to reduce weight”
Calories taken(diet) < calories burnt(exercise and physical activity)
So when we follow such diet which is low fat low carb and high protein,it helps to reduce calories reduce weight, reduce sugar, reduce cholesterol and gives a feeling of well being to patient.

2. Physical activity

Physical activity is very useful tool in managing diabetes and other noncommunicable diseases. It causes weight loss, decreases blood pressure, decreases body fat and cholesterol and it decreases stress and gives overall well being to patient. According to guidelines,moderate-intensity exercise(means exercise which increases heart rate by 50 to 70%)should be done for atleast 30min per day atleast 5days a week. We should decrease sedentary time.We should walk whenever possible wherever possible.

3. Reducing mental stress
Reducing mental stress is another pillar of management of diabetes and other noncommunicable diseases.Daily meditation and yoga helps to induce tranquility and reduce mental stress which helps to control sugar,Bp and other parameters.

Summary
Such healthy low calorie diet which include low carbohydrate,low fat and high proteinhelps to reduce weight,cholesterol and control sugars.Spacing of meals helps to prevent surges of hypo and hyperglycemias in diabetics. Exercise means walking(moderate intensity) 30min per day atleast 5days a week along with yoga, pranayam and meditation helps to burn excess calories and reduce mental stress.