Forwarded as received — Dietary advice on a Whatsapp forward

At first glance, a lot of the advice seemed pertinent. Then came some loopy, feel-good rhetoric and sweeping generalisations. And finally, some bombshells — a couple of lines that made me jump from my seat! “Eat rice 3 times a day!”, it assured diabetics.

“Forwarded as received” by my pre-diabetic father, this was surely reaching many of his diabetic friends, being assimilated into the muddle known as dietary advice for diabetics in India, and passed along thereon. Other people I knew had also independently received this very forward.

Then, as I read and re-read it, my scepticism abated a little. Why was I so bothered? Were only the medical establishment or “proper channels” equipped to issue dietary recommendations to the public? After all, that hadn’t worked out so well in the past. What we once accepted as “conventional” dietary wisdom had been turned on its head in recent decades and much brouhaha about “low fat diets” had been debunked as medically unsound, even dangerous. Even diabetologists have had to reconsider, if not revise what they had been warning people about saturated fats. No, it hadn’t worked out so well at all.

This is the age of information, after all. Wouldn’t it be a good thing if any nugget of information that was composed at least in part, of good sense and backed by scientific data, was shared around, no matter the medium? It certainly has to be a good thing, if it prompts people to look up the information themselves, question conventional wisdom and review their stagnant, failed eating habits.

Anything that can make a difference to the ramshackle state of how urban Indians increasingly source and eat their foods should be welcomed. Many of us might recognise the feeling of walking past towers of empty pizza cartons lying outside a neighbour’s door every morning. Our supermarkets are stocked with processed foods made predominantly of refined carbohydrates and sugars (foods that are essentially variations of, and vehicles for sugar), wrapped in sham wrappers that proclaim “low fat” and “goodness of fibre” in stylish light fonts, and all retail food is increasingly and expertly marketed to you by food corporations that care about nothing except their bottom lines.

Putting all this aside, the author of this particular piece was allegedly an acclaimed dietitian who was well known in Mumbai’s celebrity dietitian circles. The exact source of this forward cannot be verified although some quick searches confirm that she has indeed been reported making many of its claims. I suppose that when you’ve successfully treated (again, unverified) the highly public obesity of a member of India’s richest family, that’s some major credential to bank on. This was all very interesting but surely, it wasn’t worth taking it all at face value?

So, what happens when the son of a pre-diabetic father from a food-loving middle class family that nurtures, loves and bonds through food — who is overweight himself and treating his hypertension through clinical checkups as well as self-monitoring, independent study and an exhaustively researched dietary regimen — wants to stop the forward in its track, embed a bunch of his own notes into it and pass it along?

My remarks interject each numbered point in the original forward (quoted text). Read on.

Rujuta Diwekar is the highest paid dietician in India. She is the one who took care of junior Ambani to lose 108 kgs.

Her advice to diabetics:

1. Eat fruits grown locally ….. Banana, Grapes, Chikoo, Mangoes. All fruits have FRUCTOSE so it doesn’t matter that you are eating a mango over an Apple. A Mango comes from Konkan and Apple from Kashmir. So Mango is more local to you.

Eat all the above fruits in DIABETES as the FRUCTOSE will eventually manage your SUGAR.

This is good advice. Fructose is better than Glucose but take note that this only applies for the concentrations in which it is found in actual fruits. I have noticed some stores beginning to sell “table fructose” in jars to use in place of sugar and consuming it in this form will not be very different from taking white sugar. Considering how much carbohydrates we Indians consume anyway, my suggestion is to use stevia, which is a natural sweetener that has been used for many centuries, with no ill effects and an almost negligible impact on blood sugar. Stevia is sold by brands such as “stevi0cal” and healthkart.com sells 400grams for 550 rupees. Very little of it is needed to produce a nice, light sweetness.

2. Choose Seed oils than Veggie oils. Like choose ground nut, mustard, coconut & til. Don’t choose chakachak packing oils, like olive, rice bran etc.

Go for kachchi ghani oils than refined oils.

Good advice. It’s always good to avoid oils that are high in Polyunsaturated fatty acids. The “saturated fat is bad” hypothesis has been conclusively and thoroughly debunked. And yes, “Kachchi ghani” or “Cold presssed” oils are indeed better than more heat and chemical-processed refined oils.

3. Rujuta spends max time in her talks talking about GHEE and its benefits.

Eat GHEE daily. How much GHEE we should eat depends on food. Few foods need more GHEE then eat more and vice versa. Eat ample GHEE. It REDUCES cholesterol.

Yes, ghee is very good for your health. Ghee is an excellent source of healthy fats but because it is calorie-rich, you do have to watch and pull back the carbs you eat with it to really make the most optimal use of its calories.

4. Include COCONUT. Either scraped coconut over food like poha, khandvi or chutney with idli and dosa.

Coconut has ZERO CHOLESTEROL and it makes your WAIST SLIM.

Again, great advice. Coconut oil, just like ghee, contains MCTs (medium chain triglycerides) that are among the easiest and healthiest forms of fats to metabolise. Again, pull the carbs back because an excessive blood glucose level will impair the body’s ability to use fats (when blood glucose and therefore insulin level is high, all the energy from the food will be simply stored away in fat cells).

5. Don’t eat oats, cereals for breakfast. They are packaged food and we don’t need them. Also they are tasteless and boring and our day shouldn’t start with boring stuff.

Breakfast should be poha, upma, idli, dosa, paratha.

100% agreed. Breakfast oats, the way Indian stores sell it — rolled or finely cut, almost powdered — is really not good for you. It loses all the low GI properties that steel cut oatmeal or whole oat groats offer. This is true especially of “masala oats”, etc. From what I’ve found out, the same companies (like Quaker) that sell “steel cut oats” in US, Australia etc, a form that takes over 10–12 minutes to properly cook, prefer to market and sell more processed oats (steamed-rolled-toasted) varieties in India , which take barely 3 minutes to cook. The “instant” version of anything is worse for your blood sugar than the “whole” or “close to whole” version.

Traditional Indian breakfasts should be consumed strictly in moderation by diabetics. Just because they are “traditional” doesn’t mean that with the sorts of lifestyles we have in the year 2016, we can continue eating them neglecting all other factors. I will elaborate below.

6. Farhaan Akhtar’s New ad of biscuits — fibre in every bite… Even ghar ka kachara has fibre, likewise oats have fibre. Don’t chose them for fibre. Instead of oats, eat poha, upma, idli, dosa.

Agreed. Yes, “added fibre” has no proven abilities to help anything except maybe to aid better motion — an area which Indian diets need little help with anyway. The only kind of soluble fibre which has been shown to help with reducing cholesterol levels is “beta-glucan”, which is found in oats and much more, in barley. But increasing fibre intake while ignoring excessive starch consumption (pure grains, biscuits, etc) negates any positive health benefits of “high fibre”. All commercially sold biscuits, whether regular or sugarfree, are terrible for diabetics. Nutritionally, they contain on average at least 65% net carbohydrates and with the kind of processing involved in manufacturing them, you may as well be eating spoonfuls of sugars directly.

7. No JUICES till you have teeth in your mouth to chew veggies and fruits.

Agreed. Eating whole fruits is better for you in every respect.

8. SUGARCANE is the real DETOX . Drink the juice fresh or eat the SUGARCANE.

This is not good advice. The reason sugarcane was traditionally so good for you had a lot to do with how much physical effort went into chewing them to get the juices out, how seasonal their availability was (harvest time, when people were anyway very busy) along with how little processed sugar was available in those times. With the growth and universal dominance of the processed sugar industry over the past 150 years, all of this is much less relevant and should be examined on the whole or treated with caution. Drinking sugarcane juice is not very good for diabetics.

9. For pcos, thyroid — do strength training and weight training and avoid all packaged food.

Great advice. Strength training has tremendous health benefits, especially for PCOS and thyroid patients. In general, regular exercise must be a part of the lives of all diabetics as well as people of all ages with all kinds of medical vulnerabilities be it hypertension, diabetes, PCOS or thyroid abnormalities, etc.

10. RICE — eat regular WHITE RICE. NO NEED of Brown rice. Brown rice needs 5–6 whistles to cook and when it tires your pressure cooker, then why do you want to tire your tummy. 
 A. white rice is hand pounded simple rice. Rice is not high is GI INDEX. Rice has mediun GI index and by eating it with daal / dahi / kadhi we bring its GI index further down. If we take ghee over this daal chawal then the GI INDEX is brought further down.
 B. Rice has some rich minerals and you can eat it even three times a day

Wrong. Wrong. This is terrible advice. First of all, that cooker analogy is nonsense. Your body is not a pressure cooker and does not process anything with steam or heat but with enzymes. Secondly, if this analogy made sense, it could extend to EVERY COOKED FOOD EVER. Imagine reading “Rajma beans take 5–6 whistles to cook then why do you want to tire your tummy” — see what I mean? It is not useful to take some superficial observation and then form an analogy to human health with it.

The benefits of brown rice extend far beyond its fibre content. a) Brown rice is much lower in GI than white rice — this really means, eating it spikes the blood sugar less drastically than eating white rice does and I cannot emphasise enough how important this is for diabetics b) Brown rice is much richer in different micro-nutrients (vitamins and minerals) than polished white rice, and these play a very important role in so many body functions (aiding digestive enzymes, helping your immune system, strengthening your bones, etc). All in all, eating white rice regularly is disastrous for diabetics if they are to get serious about controlling their blood glucose spikes.

But it is true to that eating rice with ghee and lentils, etc will lower its blood glucose impact. Never forego those vital proteins and fats because they should help you control how much quantity of just the rice you eat and they do help bring down the glycemic index of the meal and thus, keep your blood glucose in check besides keeping you sated or longer.

11. How much should we eat — eat more if you are more hungry, let your stomach be your guide and vice versa.

This is not very practical advice. One of the main lessons I learnt from my experiments with first, low carbohydrate and then controlled-carbohydrate-GI, calorie-restricted diets is that your brain’s ability to interpret the stomach’s signal to you of “how full it feels” can be very off, after decades of eating carbohydrates and forgetting what real “fullness” feels like. I find that “eat with your eyes” is good advice — don’t chomp down your meals hastily, pay attention to what you’re eating, chew properly and savour each bite. But also, exercise some will power and learn to stop eating once you feel “sated” i.e. not hungry any more. And of course, eat plenty of proteins and fats (lentils & ghee for e.g.) with your meal so that you can do with eating less of the carbohydrates and in turn, remain sated for longer and thus, get hungry again less soon.

12. We can eat rice and chapati together or only rice if you wish. It depends on your hunger. Eat RICE in ALL THREE MEALS without any fear.

Ugh. This is irresponsible, rubbish advice.

It is advisable to control your carbohydrates — both quality and quantity — at every meal, regardless of meal times.

One useful suggestion for chapatis is: make them with barley flour instead of wheat (barley has lower GI on top of having less potentially inflammatory gluten) and also, add maybe a sixth portion of of soy flour or besan (bengal gram flour) to the flour to shore up the proteins and further reduce the GI. Finally, add a mixture of ground spices into the chapati flour such as asafoetida, fennel, a little turmeric and especially, fenugreek seed powder — which has excellent blood sugar-controlling properties — to improve the taste as well as impart all of the enzymatic and other benefits that these traditional Indian spices do. Your chapatis will be healthier, taste better and more “earthy”, you will eat less of them and remain satisfied for longer.

13. Food shouldn’t make you scared like eating rice and ghee. Food should make you FEEL GOOD.

Hard to disagree with “Food should make you FEEL GOOD.” But making healthy eating and lifestyle choices and staving off diabetes will make you feel better than any single meal ever can.

14. NEVER look at CALORIES. Look at NUTRIENTS.

Take this advice with a pinch of salt. Yes, don’t look at calories alone and never make poor choices such as, for example, substituting a full packet of biscuits for a cup of peanuts simply because they have the equal number of “calories”. Yes, it is true that meals are about a lot more than can be reduced to a simple number. HOWEVER, calorie restriction in practice — both in terms of intermittent fasting as well as GI-controlled, calorie restricted meals — has tremendous implications for controlling, halting and even “reversing” diabetes.

15. No bread, biscuits, cakes, pizza, pasta.

Agreed. These are all terrible substitutes for real food. If you crave breads, cakes and pizzas, make them at home. Make sugar-free cakes with just fruit pulp (such as carrots or bananas), some butter and a moderate quantity of a mixture of barley & millet flours. Make homemade sourdough breads and sourdough pizzas — once you discover the miracle of sourdough (“slow fermentation dough”) foods, especially as a diabetic, you will never go back to commercial varieties of breads.

16. Ask yourself is this the food my Nani & Dadi ate? If yes then eat without fear.

Did your Nani and Dadi have cars to take them everywhere, apps that deliver food at home, sedentary desk jobs with crazy working hours, televisions to plant themselves in front of, limited avenues for exercise and the variety of processed foods to choose from in their time? Did your Nani and Dadi have “modern roller flour mills” (that wreak havoc on the nutrients of the grains while processing them) in every street corner or preprocessed, homogenous 10 or 20 kgs flour bags packed and marketed by agro giants available in department stores or online or… did they have to grind their own flours at home or get it done in neighbourhood stone burr chakkis themselves? So much has changed in the realm of food and nutrition over the last half-century or even 25 years that one cannot make these types of simplistic comparisons with any degree of usefulness.

17. Eat as per your season. Eat pakoda, fafda, jalebi in monsoon. Your hunger is as per season. Few seasons we need fried food so eat them.

This is good advice when applied especially to fruits and vegetables. Beware of pakodas, jalebis etc because they’re calorie-intense, packed with carbs and sugars and are overall, not good for diabetics to eat.

18. When not to have chai — tea — don’t drink tea as the first thing in morning or when you are hungry. Rest you can have it 2–3 times a day and with sugar.

Yes, don’t drink caffeinated drinks on an empty stomach because they can induce acidity.

For God’s sake, if you are diabetic, stop taking sugar with your cups of coffee or tea. You have to control your carbohydrate and sugar consumption in every spoon and in every portion of every meal. This is the hard truth so get used to it.

19. NO GREEN tea plesse. No green, yellow, purple, blue tea.

Green tea is full of antioxidants and has been proven to have tremendous health benefits for people of all ages and conditions. You can look it up anywhere. In fact, regularly drinking a variety of green teas is credited as being one of the factors responsible for the amazing health and longevity of senior citizens in many East Asian cultures. I don’t understand the author’s aversion to this wonderful drink.

20. Eat ALL of your TRADITIONAL foods.

One does not have to be scared of eating traditional foods but once again, remember to be vigilant of the carbohydrates you consume when you are diabetic. This cannot be emphasised enough.

21. Strictly NO to packaged foods / drinks.

Good advice.

22. Exercise / Walk more to digest & stay healthy.

Great advice.

Regards,
 Rujuta Diwekar
 Forwarded as received

My responses that you can see above, were based on my own independent research and to back me, I provided as many references as I could. I found that a lot of the author’s “advice to diabetics” was good but some of it seemed unsound and was disconcerting to read. If you disagree with my counter-arguments, please conduct your own research and draw your own conclusions.