Summary

Diabetics and elders are at risk of various age-related conditions. Regular exercise and the right diet go a long way in preventing these conditions and ensuring optimal health. In this context, it is important for diabetics and elders to know the glycemic index of common foodgrains and which make for a better choice. They should also understand what is glycemic load and why it’s important. Together with glycemic index, this will help arrive at the right diet-plan. This article is for awareness only and not meant to replace a doctor’s advice. Elders and diabetics should consult a doctor and nutritionist to arrive at the right diet for them.

What is Glycemic Index?

Our body sustains itself from glucose absorbed from food, and the oxygen in the air. While oxygen is inhaled while breathing, carbohydrates consumed through food supply the necessary glucose. After consuming a meal, the glucose from food enters the bloodstream and this raise the blood-glucose level. Insulin, a hormone secreted by the pancreas pushes the glucose into all the body cells. There, oxygen and glucose are burnt, to provide energy and sustain the person. After this event, the blood-glucose level drops automatically. Some of the excess glucose not required to produce energy is stored in the muscles and liver as fat. When one is starving, these reserves are burnt, to provide the required energy. This process is aided by another hormone secreted by the pancreas called glucagon. This is the common cycle in a healthy person.

Type-1 diabetes is a condition in which the body does not secrete enough insulin, so there is a huge surge in blood-sugar level after a meal (called post-prandial blood-sugar level). This can be dangerous for the health of the person, so he/she must take artificial insulin regularly, for normal functioning of the body.

Type-2 diabetes is a condition in which the body secretes enough insulin but the body cells are not able to use that to convert the blood-glucose into energy. There is said to be an insulin-resistance in the body. This is generally managed through medication.

For both Type-1 and Type-2 diabetics, exercising regularly and consuming the right diet becomes important to keep blood-sugar levels in control. So, from a diet perspective, knowing the glycemic index (GI) of all foodstuff they consume becomes important. In this article, we will stay focused on GI of food grains only, and not all foodstuffs.

Glycemic Index is a number that is accorded to food, and indicates how much or how quickly does the blood-sugar level increase after consuming it. This is calculated with reference to white-bread as the benchmark. White-bread made from refined wheat-flour causes rapid surge in blood-sugar level and that’s why, this is taken as 100, which is the maximum number. All other foods will have a GI less than 100, and they are graded in the below manner.

• Low GI: score of 55 and below
• Medium GI: score of 56-69
• High GI: score of 70 and above

Low GI foods mean they take longer to digest, so they raise the blood-sugar levels slowly. In contrast, high GI foods digest quickly, so they raise the blood-sugar levels quickly. For example, maida (refined wheat-flour) and table sugar (white sugar) raise blood-sugar levels quickly, so we are always cautioned against consuming them.

Needless to say, low and medium GI food grains are preferable for diabetics and elders, for regular, or day-to-day consumption. High GI food grains can be consumed once in a while, provided portion control is taken care of, and the meal has a good quantum of proteins, healthy-fats, vitamins and minerals in it. This way, GI of the entire meal gets averaged out. This is because fibre found in vegetables and fruits (both cooked and raw), fat and protein do not cause a surge in blood-sugar level as much as carbohydrates do, because of the sugar content in them.

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Also Read: What is Glycemic Index? Why it is relevant for Diabetics?

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Glycemic Index of common food grains

In this context, let us know the GI value of common food grains consumed in India, or TN specifically. We will stay focused on rice, wheat and the 8 commonly available millets.

English Name	Tamil Name	GI value
Brown/Red Rice	Siggappu-arisi	50
White Rice	Pacha-arisi	89
Whole Wheat (as in whole wheat flour)	Godhumai	45
Barnyard millet	Kuthiraivali	42.3
Kodo Millet	Varagu Arisi	65.4
Little Millet	Samai	64.2
Foxtail Millet	Thinai	54.5
Proso Millet	Panivaragu	52.7
Sorghum	Cholam	61.2
Finger Millet	Kezhvaragu	61.1
Pearl Millet	Kambu	56.6

What is Glycemic Load?

So, is Glycemic Index the absolute measure of how healthy is the food, for a diabetic or elder? Not really! The quantity of the foodgrain consumed also matters. Two servings of a low-GI food can increase the blood-sugar level to the same extent as one serving of a high-GI food. Only the pace at which the blood-sugar levels increase varies, that’s all. This means, a diabetic or elder who is liberally consuming low-GI foods is still putting his/her health at risk. Portion control, or how much quantity of that foodgrain is consumed also matters.

That is why, over time, another parameter called Glycemic Load (GL) has been created. This is calculated as follows:

GL = GI × available carbohydrate in grams /100

GL is categorized as follows:

• Low GL: score of 10 or less
• Medium GL: score of 11–19
• High GL: score of 20 or higher

It is also important to remember that nobody consumes carbohydrates alone in a meal. A balanced meal consists of protein sources (lentils, beans, eggs, meat and dairy), healthy fats (ghee, butter, coconut oil, peanut oil, sesame oil, mustard oil) fibre from vegetables (cooked or raw) and fruits, and finally vitamins and minerals from all these sources. So, nett-nett, the GI of an entire meal averages out. However, in the same context, it is important to understand GI and GL, because the choice of foodgrain and the quantum consumed, with relation to the quantum of proteins, fibre and fats consumed, can alter GI and GL value of the meal, accordingly.

So, GL gives a better idea of how food impacts the blood-sugar levels by considering all these points:

• Carbohydrate sources: The type of sugar and starches in the food (which food grain, which tubers are part of the meal. Tubers refers to starchy vegetables like potato, sweet potato, elephant foot yam and tapioca)
• The way the food is prepared (cooked, semi-cooked, raw, shallow-fried, deep-fried, roasted, barbecued, etc.)
• Fat content (the choice of fat sources and how much is used)
• Fibre content (how much of vegetables are consumed in relation to how much of proteins, fats and carbohydrates)
• Serving size (how much food is consumed in that meal)
• GI value of these food ingredients

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Also Read: Diabetes & Fruits Consumption – Should You, or Shouldn’t You?

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Why should diabetics and elders be careful?

We have already discussed what is Type-1 and Type-2 diabetes, and how people affected by the condition should consume low-GI food grains, and a low-GL meal, to ensure good health. If diabetics consume high-GI food grains or in general a high GL-meal, then blood-sugar levels increase drastically, leaving the person fatigued after some time. The rapid digestion also confuses the brain which signals that a person needs food again, so after 2-3 hours, the person feels hungry again.

Eating again when hungry, repeats the entire cycle. Long-term consumption of high-GI and high-GL meals by a diabetic can damage the eyes, kidneys, heart and peripheral nervous system, leading to various complications. In contrast, a low GI/GL meal will slowly release sugar into the blood. The person feels satiated after a meal and does not feel hungry for quite some time.

All the above is applicable to diabetics, who may be of any age (young/middle-aged/senior). What about elders, who are not diabetic? Why should they be careful?

In seniors (60 years and above), one of the normal consequences of ageing is that intracellular body-water decreases, deposits of body fat increases and muscle mass decreases. All these can lead to insulin resistance and Type-2 diabetes. While the glucose output from the liver (when one is starving) remains normal with age, the function of pancreatic-islet-cells reduces, which means, insulin production also reduces slightly. This rate is 0.7% per year with advancing age in non-diabetics and double (1.4%) in those with Type-2 diabetes.

Older people who develop type-2 diabetes later in age, have normal fasting glucose-levels but high post-prandial (after meal) glucose levels. This can lead to hyperglycaemia or high blood-sugar level. The only way to reverse this age-related decline, or at-least slow it down, is regular exercise, and changes to the diet. In fact, these measures have shown to successfully reduce type-2 diabetes by 58% in older people. That is precisely why, both diabetics and elders should be aware of the GI and GL values of food they are consuming regularly.

How to arrive at the right diet-plan?

All this information can be daunting if you are a diabetic or non-diabetic elder. Which food grain is preferred and how much must be consumed in a meal? How many meals per day should one consume? How much of fats is good and which are the best fats to consume? How much protein is required to ensure optimal repair and maintenance of body-tissues? Well, to answer such question, one generally enquires of their friends and family, or nowadays look up the Internet. But this is not an advisable method, as the wrong information can put their health at risk.

What you should do is to consult a reputed hospital in their city. Such hospitals have diabetologists, geriatric care (elders’ health) specialists, dieticians and nutritionists on their rolls. They will do a thorough medical check, which covers bone-density tests and muscle-fitness tests, along with heart, kidney and pancreatic health. Thereafter, they will understand your present diet and lifestyle which covers exercise and other habits, your ability to exercise, diet-preferences, etc. Then they will design a diet-plan that covers the number of meals, portion size of each meal, and what all should go into the meal. They will even advise you on dos and don’ts and how to take care of emergencies. Armed with this information, you can live a more peaceful life without constantly worrying about your health or the outcome of your actions.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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