Release Issue by nutritioninsights

Released issue

NUTRITION INSIGHTS food for thought, thought for food

Reality check ahead Myths & Facts

Diabetes is one of the most common metabolic disorder that is affecting humankind.

Find out why ? Superfoods

Diabetes is one of the most common chronic non-communicable life style disorders, and sadly India is on the verge of becoming the next Diabetes capital in the world.

Stick to it Excercise

Regular exercise is an essential aid for optimal health but it also plays a key role in management of diabetes along with diet and medications.

Sugar Regimen

Editor's Note Welcome to the ﬁrst issue of Nutrition Insights. Nutrition Insights in the form of a magazine, is an endeavour to create a virtual meeting space which focuses on evidence-based nutrition content and features recipes, tips, and expert advice geared toward the prevention and better management of chronic diseases and lifestyle. Nutrition Insights is published by Nutriture wellness LLP, an initiative towards awareness of food and nutrition, and nutrition community of India. Here at nutrition insights we will provide the inspiration and information people need, to make healthy eating choices more exciting with moderation and balance. We would strive to make healthy living accessible, sustainable and—above all—delicious. It would not only discuss research based articles, but also we would share case studies, recipes, interviews and lot more, which would be journey of theory to practical. We endeavour to employ our resources and share our learning’s to help the community at large. The ﬁrst issue of Nutrition Insights focuses on one of the major chronic diseases in India, “DIABETES”. It is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. According to WHO, Diabetes is a growing challenge in India with estimated 8.7% diabetic population in the age group of 20 to 70 years. Let us know what you think of us. We’re not wedded to any format, style, or philosophy. We want Nutrition Insights to be an expression of as many different voices as possible, so all contributions are welcome. Our next issue is on Gluten and its trends, details for it can be found on our website, www.nutritioninsights.in.

Editor : Bansari Rao Managing Editor : Sonu Mishra Copy Editor : Hetali Shah Design & Layout : Pooja Ashra Contributors : Tejal Lathia , Sampada Kulkarni, Bhoomi Shah, Rabia Mistry, Ruchita Maheshwari, Anita Varier, Suchita Kalyansundaram, Avani Shah, Shweta Mahadik.

NUTRITION INSIGHTS food for thought, thought for food

Contents

Release Issue

Role of Nutritional ModiďŹ cation

Top 5 Tips to Manage Pre-Diabetes

The Superfoods

Case Stdy

Debunking Myths Exploring Facts

Exercise and Diabetes

In Conversation with.....

Food Corner

Research

Nutri Meter

Role of Nutritional modification To quantitate the impact of nutritional modification on diabetes management is a herculean task. It is one of the most formidable weapons in our armamentarium in the fight for diabetes along with exercise and medication. I would like the reader to note how I will consistently use the word modification through the article. Diet intervention does not necessarily mean reduction of food intake which most diabetics fear. Intervention may be increase or decrease in calories, change in composition of the diet (fat/carbohydrate/protein proportion). It may mean change in glycemic index or complexity of carbohydrates or addition of foods providing vital minerals, vitamins and fiber. The major role of nutritional modification to my mind is in those with strong family history of diabetes or prediabetes. In both these situations, timely intervention may very well delay the onset or progression of diabetes by decades. A doctor I know has kept her HbA1c (a marker for long-term blood sugar levels) at 6.5% for a decade by diet modification and exercise alone whereas her daughter already has diabetes. The Diabetes Prevention Program (DPP) was a 27-center randomized clinical trial to determine whether lifestyle intervention or pharmacological therapy (metformin) would prevent or delay the onset of diabetes in individuals with impaired glucose tolerance (IGT) who are at high risk for diabetes. Lifestyle intervention decreased the incidence of type 2 diabetes by 58% compared with 31% in the metformin-treated group1.Concluding, nutritional modification is more powerful than even medications in prediabetes. Another major role of nutrition comes into play when patient’s diabetes is uncontrolled on oral medi-

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cations.It is time for doctor and patient both to accept that insulin production from pancreas is no longer sufﬁcient and no matter how little a patient eats, sugar will still be high. It doesn’t mean the work of the nutritionist is over however, it has just begun! Now food intake and insulin needs to be matched. Too much insulin and too little food -hypoglycemia. Too much food, not enough insulin - hyperglycemia. Insulin injections do not understand whether patient has eaten or not, so we need to make sure small frequent meals are consumed to prevent low sugars. There will be days when patient will want to eat more, extra insulin will be needed to cover these meals. So detailed explanation, frequent visits to the nutritionist and constant revision as per patient needs. Mr XYZ, one of our recent patients at Fortis Hiranandani Hospital, Navi Mumbai highlights this situation. He was an elderly, long standing diabetic with a pacemaker implanted a week ago. This man had been discharged from hospital with a reasonable sugar control. After going home, his sugars dramatically increased, averaging 350-400. His cardiologist could not understand the problem. He referred the patient to me. The son had been doubling the doses of insulin every second day, almost upto 20 units three times a day but to no avail. Sudden increase in blood sugars without any coincident infection led us to suspect food intake as the culprit. My nutritionist took a food recall. Mr. XYZ, recently released from the hospital (where he had to eat a salt restricted diet) was guzzling huge amounts of farsan (deep fried gram ﬂour products). Due to the rapid escalation of insulin doses, he was having frequent hypoglycemia and eating even more, perpetuating a vicious cycle. All we had to do was cut down the farsan and reduce the

Role of Nutrition Modification

Your genetics load the gun, your life style pulls the trigger -Mehmet Oz insulin doses… and lo and behold! Sugars were well controlled. If we had not evaluated food intake, we would have needlessly increased the insulin leading to a vicious cycle of hypo and hyperglycemia. In Type 1 diabetic, nutritionist has a vital role. Carbohydrate counting at each meal with use of insulin: carbohydrate ratio and insulin sensitivity factor to estimate nutritional and correctional dose is taught by the nutritionist. Does it really improve glycemic control, quality of life or reduce hypoglycemia? What is the evidence that this is useful to a type 1 diabetic? Quite frankly, the data is conflicting. GIOCAR2, a prospective randomized controlled trial published in Diabetes Care showed that among adult patients with type 1 diabetes treated with CSII (continuous subcutaneous insulin infusion), carbohydrate counting is safe and improves quality of life, reduces BMI and waist circumference, but in intention-to-treat analyses, there was no difference in HbA1c. In contrast, the DAFNE study published in BMJ3 which evaluated whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemia control and quality of life in type 1 diabetes, found that skills training promoting dietary freedom improved quality of life and glycemic control (~ 1%) in people with type 1 diabetes without worsening severe hypo glycaemia or cardiovascular risk. A meta-analysis in 2016 identified a significant decrease in HbA1c concentration with carbohydrate counting versus other diabetes diet method or usual diabetes dietary education (SMD: −0.35, 95%CI: −0.65 to −0.05, P = 0.023). It concluded that carbohydrate counting may confer positive impact on glucose control.

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Larger clinical trials are warranted to validate this positive impact. A 2018 meta-analysis showed evidence favoring the use of carbohydrate counting (CHOC) in the management of Type 1 DM. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group. Another place where nutrition has great importance is during pregnancy. Our pregnant women are eating huge amount of calories before as well as soon as they are pregnant. Put it down to craving, the belief that we are eating for 2 or just lack of correct information. But what we forget is that the social tradition of eating more in pregnancy was for a time where women were doing hard work and labor in the fields, managing large extended families. In the age of nuclear families and maids, we consume a lot of calories during pregnancy but do little or no exercise. Hence pregnant women gain lot of weight sometimes by the 3rd or 4th month of pregnancy. This leads to gestational diabetes quite early in pregnancy. At Apollo sugar clinic, Navi Mumbai we recently had a patient who was 24 year old lady pregnant for the second time who exemplifies role of nutritionist in gestational diabetes mellitus. She was screened for diabetes during pregnancy for the first time at 10 weeks gestation. Her Fasting blood sugar at the time was 185

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Role of Nutrition Modification and post meal blood sugar was 294. We immediately initiated her on basal bolus insulin therapy (3 injections of rapid acting insulin and 1 injection of long acting insulin at bedtime). However, all the insulin in the world would be of no use if her high carbohydrate diet (mainly simple, high glycemic index food) were not modified. It was a harrowing experience for our nutritionist as patient could not understand a single word of Hindi. She understood only her native language. All instructions were passed on through husband who was extremely supportive. Over the next few weeks, repeated consultations with nutritionist and endocrinologist were rewarded. Her blood sugars dropped gradually to well within normal pregnancy targets. What was astounding was that we were actually able to take her off insulin altogether by her 8th month of pregnancy. This case study exemplifies what wonders proper nutritional modification can achieve! A major role played by a good qualified nutritionist in diabetic patients is also to advise which diet fads they can follow and which they absolutely cannot. This is very important as a diabetic patient is bombarded with information on diabetes from lot of unreliable sources like WhatsApp videos, you tube clips and internet searches. The glitch is the veracity of these sites of information and the danger of a vulnerable diabetic looking for cure of diabetes by hook or by crook. Diets like very low carbohydrate diets (ketogenic and Atkins) may precipitate dangerous ketoacidosis in insulin-dependent patients or patients taking SGLT2 inhibitors. This is where the nutritionist can guide the patient away from harmful diets. On a closing note, a nutritionist spends far more time with the patient than the doctor. An empathetic hearing with meaningful doable interventions in keeping with patient’s lifestyle and needs leads to greatest benefit to patient. References: •The Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393-403, 2002 •Laurenzi et al: Effects of Carbohydrate Counting on Glucose Control and Quality of Life Over 24 Weeks in Adult Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (GIOCAR). Diabetes Care 34:823–827, 2011 •DAFNE Study Group: Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomized controlled trial. BMJ 325:1-6,2002 •Fu et al. Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis. Scientific Reports volume 6, Article number: 37067 (2016) •Vaz et al. Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis. Arch Endocrinol Metab. 62(3):337-45, 2018

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Dr Tejal Lathia Consultant Endocrinologist Apllo ,Fortis and MGM New Bombay Hospitals

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5 TIPSTO TOP

MANAGE

PRE-DIABETES -Ruchita Maheswari

Pre-diabetes indicates you have blood glucose, or blood sugar levels that are higher than normal but not high enough to be called as diabetes. If you have pre-diabetes you are more likely to develop type 2 diabetes, heart disease, and stroke. “Diabetes”, the word itself is enough to create fear amongst most people. Almost everyone knows about it (even if superficially), so what is this ‘Pre-Diabetes’ that we are talking about? If you are detected with ‘Pre-diabetes’, is there anything to fear?

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top 5 tips to manage pre-diabetes 1.Eat Breakfast within an hour waking up

Start your day right! Make sure that you eat a wholesome breakfast. If it is not possible, try to have few nuts or a fruit (that fruit can be a banana too!!) as this is essential to boost your metabolism & start your day with energy. As the word ‘breakfast’ itself suggests you have to break your fast after a good 6-8 hours of sleep.

2.Start practicing mindful eating & portion control

Avoid distractions while eating like watching TV or videos, gadget usage, talking, etc. Make sure that while eating you only focus on food so that you are mindful of what you are eating. Also choose a smaller plate as it will help you to maintain portion control.

3. Choose sugar over artiﬁcial sweeteners

Prefer sugar, natural sweeteners like coconut sugar, organic honey, stevia, dates in daily routine where sweetness is required. It is far more advisable to use these as they impart some nutrition as compared to artificial sweeteners (like aspartame, sucralose often known as Splenda, saccharin, sorbitol) which can prove dangerous for us in the long run. Artificial sweeteners may indirectly affect metabolism that can be detrimental to one’s efforts of trying to lose weight and slow down the progression of pre-diabetes. Unfortunately, we end up consuming these artificial sweeteners in hidden form regularly in toothpaste, mouthwash, alcoholic & non-alcoholic beverages, candies & many more. Thus 1 glass of lemon juice is much safer than 1 glass of diet cold drink. (Tip: Adding 1 teaspoon chia seeds to lemon juice help to release sugar in blood slowly).

4. Eat frequently

Eating a small meal or snack every four to ﬁve hours can help in achieving glycemic control. The stomach empties itself every three to four hours, so if you go much longer without eating, your blood sugar levels could nosedive, causing you to overeat at your next meal. By eating regularly throughout the day, you can more easily spread out your carbohydrate intake. This way you are never eating a lot of carbohydrates at a time so your blood sugar doesn’t spiker

5. Follow balanced diet

Make sure that you don’t end up following any fad diet in order to lose weight as in this situation you can end up damaging your body and end up paying heavily. Eat plenty of high-fiber foods including vegetables, fruits, beans, and whole grains. Fiber helps you feel fuller for longer and can help you eat less and eventually avoid weight gain. Include at least 3 servings of fresh veggies & 1 serving of fresh fruit. Opt for the healthier fat sources like olive and vegetable oils (Changing cooking oil every now and then is recommended so that nutritional requirement is fulfilled), nuts, seeds, etc. Buy low-fat products such as low fat paneer, low-fat yogurt, and skimmed milk. Opt for white-meat chicken over red meat. Adding fish to your diet two to three times a week is part of a diet that can help in diabetes prevention. Bake, broil, roast, grill, or sauté rather than fry for a fat-controlled diet.

Can you reverse Pre-Diabetes?

Whenever we hear about any illness, the ﬁrst question that comes to our minds is – Is it reversible? Surprising this time the answer is a yes. Prediabetes can be easily prevented or even reversed. One can start by simply following healthy & balanced diet. At this point of time, low carb or high protein or no fat diet (which is usually the modus-operandi in medical nutrition therapy for diabetes) is not recommended as it can make the diet imbalanced and it can prove to be counterproductive and increase your risk of diabetes. PreDiabetes Diabetes

Diabetes Test

Normal

Hemoglobin A1c, %

< 5.7

5.7–6.4

≥ 6.5

Fasting blood glucose, mg/dL

< 100

100-125

> 125

Post meal, mg/dL

< 140

140-199

> 199

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THE SAMPADA S. KULKARNI REGISTERED CLINICAL DIETITIAN CERTIFIED DIABETES EDUCATOR

Diabetes is one of the most common chronic non-communicable life style disorders, and sadly India is on the verge of becoming the next Diabetes capital in the world. Its prevalence is rapidly increasing in both urban and rural sectors of the nation. Diabetes is characterized by constant elevation of blood glucose levels due to deficiency of action or secretion of hormone Insulin. It hampers the metabolism of carbohydrate, proteins, and fats. The major causes of diabetes include a strong family history, sedentary lifestyle, poor dietary habits, smoking, and alcohol consumption. Due to urbanization and a busy lifestyle, Indians tend to be more inclined towards western dietary patterns which includes intake of processed, ready to cook, ready to eat and refined products. As a result of processing, the food stuffs loose the essential nutrients and fibre, making the products feeding machines for obesity and diabetes. We often fail to understand the importance of our traditional Indian cuisine, which is diverse in nature and full of nutrients. Traditionally Indians used ‘Thali system’ which contained foods from different food

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groups making each meal wholesome and healthy. Additionally, they used a variety of spices in the preparations which not only added taste but also acted as excellent antioxidants. But now we see a visible shift from a well-balanced diet towards a high carbohydrate, high fat and low fibre diets leading to increased oxidative stress in the body. Antioxidants have the capacity to fight against free radical attack. Along with endogenous antioxidant enzymes, the body uses dietary antioxidants to fight against oxidative stress. But when the diet fails to provide sufficient antioxidants, oxidative damage takes place in the cells leading to undesirable consequences like cell damage and cell death. Increased oxidative stress in diabetes can lead to complications such as cardiovascular, renal and retinal damage. Though drug therapy plays a major role in treatment of diabetes, these complications can be prevented with the use of simple kitchen ingredients in our food which happen to be great antioxidants.

The superfoods Cinnamon

Cinnamon is one of the world’s oldest spices. Medicinal uses of cinnamon are depicted in Ayurveda texts over 6000 years old. The essential oils in cinnamon (cinnamon bark oil and eugenol) impart it its characteristic flavour and also aroma to the food. It possesses numerous pharmacological activities including antioxidant, anti-allergenic, antimicrobial and anti-inflammatory properties. Cinnamon is used in treatment of type 2 diabetes. It helps in alleviating signs and symptoms of diabetes and insulin resistance. In-vitro studies conducted on cinnamon extracts showed improved insulin receptor function by activation of enzyme that causes insulin to bind to cells and inhibition of enzyme that blocks this process which in turn is associated with increased insulin sensitivity. Insulin resistance and hyperinsulinemia are one of the common symptoms in polycystic ovarian syndrome esp. in overweight women. Study conducted by Wang et al. on women with PCOS showed beneficial effect with cinnamon consumption. Oral cinnamon extract consumption showed significant reduction in fasting glucose and insulin resistance with oral glucose tolerance test (OGTT) showing 21% reduction in mean glucose.

Vitamin D and Calcium rich foods

Both Vitamin D and Calcium are required for bone development and density. Vitamin D is also a great antioxidant which helps improve body’s immune capacity to ward off infections. Although the exact mechanism is unknown, calcium and Vitamin D are useful in the prevention of type 2 diabetes. A cohort study conducted on middle aged women showed that vitamin D and calcium were inversely associated with development of type 2 diabetes. But, this effect was shown with use of supplements rather than dietary intake. The active form of vitamin D (1, 25-dihydroxyvitamin D3) down regulates renin-angiotensin system (RAS) which plays a major role in development of diabetic nephropathy. Study conducted on mice showed that those mice that lacked vitamin D receptors were more susceptible to hyperglycaemia-induced kidney injury than their counterparts. Though sunlight is the best source of vitamin D, the possible health risk by UV rays is dangerous. Early morning exercise in sunlight can improve vitamin D levels and thereby calcium metabolism. Other sources include milk and milk products, egg yolk, cod liver oil, ﬁshes like sardines, mackerel, salmon etc.

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the superfoods Garlic Rasam This dish is the ver� deﬁnition of comfor� food. Packed with the power of garlic, it works as a g�eat appetizer(soup) or as an accompaniment with rice(any kind) or even cooked broken dalia/lapsi(broken wheat).

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Ing�edients: Garlic- 10-12 cloves Tur�eric - 1/2 tsp Salt to taste Tamarind- a small lemon sized piece Coriander seeds- 1/2tsp Tur Dal- 1/2 tbsp Black pepper- 2-3 tsp( or to taste)\ Mustard seeds- ½ tsp Ghee- 1/2tsp Cur�� leaves- 7-8 Method: Soak the t�r dal, peppercor�s,coriander seeds in water for half an hour and g�ind into a paste. Peel the garlic and slightly cr�sh it. Soak tamarind in war� water and squeeze out the juice. Heat about 2 cups of water and add t�r�eric powder, salt and the garlic Aﬅer a couple of minutes of boiling, add the tamarind water.

Turmeric

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Garlic and its preparations are widely used across the country for its taste as well as medicinal properties. It is particularly used for the prevention as well as treatment of cardiovascular diseases such as hypercholesterolemia, hypertension and thrombosis. The active component of garlic is Allicin. Allicin and sulphur containing compounds present in garlic impart the medicinal effects. Studies have shown varied mechanisms on hypoglycaemic effects of garlic. The effect is possibly due to an increase in ability of pancreas to secrete insulin from B-cells or enhancement in insulin sensitivity. Another mechanism proposed by researches suggests that the possible beneﬁts of garlic in diabetes are obtained due to its antioxidant properties. Studies conducted on humans indicated lipid lowering properties of garlic in its powder form. A signiﬁcant reduction was found in serum triglyceride and serum cholesterol levels. The effect was due to its capacity to reduce lipid content in arterial wall. Garlic decreases activities of lipogenic and cholesterologenic enzymes in liver and enhances excretion of cholesterol. This dual action is responsible for the anti-atherosclerotic property of garlic.

Pickled ginger and Tur�eric (Mangai-injee)

This is a t�aditional Indian pickle recipe which can add a zing to your meals. Both Tur�eric and ginger act as superfoods for diabetes, and the vitamin C from lemon juice acts as a cher�� on the cake. Ing�edients: Tender mango-ginger (cleaned and cut into thin juliennes)- 1/2 cup Tur�eric root (cleaned and cut into thin juliennes)- 1/2 cup Lemon juice- 2 tbsp Green chillies(slit)- 2-3 (or as per taste) Salt to taste Method: In a clean sterilised glass jar, put together all the ing�edients. Put on the lid and store it in a clean dr� place. It can be consumed aﬅer 2-3 days and can be stored in a refrigerator for 10-15 days.

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What is Indian food without turmeric? Turmeric is widely used for its colouring, ﬂavouring and medicinal properties. Little did we know before that the active component of turmeric (Curcumin) is a potent antioxidant. The most common complication of chronic diabetes is hyperlipidaemia. High cholesterol if not treated in time can further add to diabetic complications such as decline in kidney function, cataracts etc. Dietary curcumin (from turmeric) is found to have the ability to decrease the extent of lipid peroxidation in diabetic condition thereby reducing serum cholesterol levels and possible prevention of complications. Diabetic nephropathy is a result of chronic hyperglycaemia and resultant free radical attack on the kidneys. Studies done on diabetic rats concluded that those with curcumin treatment showed improved renal function and reduced oxidative stress. The results were evidenced with improved creatinine and urea clearance.

Garlic

The superfoods Omega 3 rich foods

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Omega 3 fatty acids are unsaturated fatty acids. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the constituents of omega 3 fats. They are an essential component of cellular membranes throughout the body esp. in brain. Omega 3 fats are known as the ‘good’ fats as they reduce the LDL cholesterol and improve HDL cholesterol levels. Chronic diabetes can put a person at an increased risk of cardiovascular diseases such as hypercholesterolaemia, hypertension, coronary artery disease etc. Although Omega 3 fat supplementation does not have a direct effect on blood sugar levels, it definitely has a positive effect in metabolic syndrome and reduction in the risk of cardio vascular disorders mainly due to their anti-inflammatory effect. Some of the best sources of omega 3 fats include cod liver oil, fish, nuts such as almonds,

walnuts, and oilseeds such as ﬂaxseeds, pumpkin seeds etc.

Probiotics

Probiotics make up the beneficial bacteria found in the gastrointestinal tract. They are referred to as ‘good’ bacteria. The most common bacterial species found in humans are Lactobacillus and Bifidobacterium. They help in the digestion and absorption of nutrients. They reduce inflammation and help fight against pathogenic bacteria, thus improving the body’s immune functions. One of the important causes of diabetes includes poor dietary habits. These habits combined with hygiene can affect the gut microbial content. Studies have shown that children with a risk of type 1 diabetes have less dynamic and diverse gut microbiota as compared to their healthy counterparts, highlighting the role of microbes. These bacteria participate in the important regulatory pathways in type 2 diabetes such as insulin signalling, inflammation and glucose homeostasis. Curd and buttermilk serve as excellent probiotic food sources in the Indian context. Other rich sources include flavoured yogurt, kefir, sauerkraut, kimchi etc. While diabetes can be exhaustive and stressful to manage, simple but power packed ingredients from nature can be of much help to reduce the physical and physiological stress and to avoid further complications. Eating right is a stepping stone towards a healthy life. It is important to note that no individual food item will suffice for obtaining positive effects in diabetes. Proceed with caution and remember - it was his greed for more gold that led to Midas’s downfall. Everything in moderation is the way to happy life. A well-balanced diet with a regular exercise regimen will help prevent diabetes and further complications in existing diabetics. References •Role of cinnamon as beneficial antidiabetic food adjunct: a review A. Sangal, 2011.•Vitamin D and Calcium Intake in Relation to Type 2 Diabetes in Women, Anastassios G. Pittas et al., 2006.•Reno protective role of the vitamin D receptor in diabetic nephropathy, Z. Zang et al., 2008.•Curcumin, the active principal of Turmeric (Curcuma Longa), ameliorates diabetic nephropathy in rats, Sameer Sharma et al., 2006.•The role of Gut Microbiota in the development of obesity and Diabetes, Othman A. Baothman et al., 2016.•Role of Spices Beyond Food Flavoring: Nutraceuticals with Multiple Health Effects, Krishnapura Srinivasan, April 2005.•Effect of garlic on cardiovascular disorders: a review, Sanjay K Banerjee and Subir K Maulik, October 2002. •Role of Garlic (Allium Sativum) in various diseases: an overview, Londhe V. P, September 2011.

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CASE STUDY

NORMALISING BLOOD SUGARS OF A HOSPITALISED PATIENT WITH KNOWN TYPE 2 DABETES MELLITUS. - Ms. Rabia. Mistry

Mr. ABC, underweight (Height = 155 cm & Weight = 45 Kg) at 62 years had a valve replacement surgery done in 2004 for which he was on Warf 4mg once a day. He is a known case of Type 2 diabetes mellitus since 7 years but he never practiced strict dietary caution. Recently he was brought to the casualty, reason being he felt uneasy with heavy perspiration, tingling sensation and numbness in his limbs, all of which started just as he was sipping on his sugar laden tea in the evening. He was immediately admitted with 335 mg/ dL blood sugar, weariness in diabetes & electrolyte imbalance.

What Medical Nutrition Therapy (MNT) was applied? The medical nutrition therapy was to administer a Diabetic diet – no simple sugars, more good proteins and with complex carbohydrates with a starting calorie budget of 1250 Kcal (25 Kcal/Kg IBW) & protein administered at 50 gm (1 gm/Kg IBW), to provide carbohydrate controlled meal plan that promotes optimal nutrition with adequate energy, so as to prevent future episodes of weariness, raised blood sugars & the current emaciated state.

Why the raised sugars? Home diet recall was taken & calculated, which showed that his calorie intake was roughly 1100 calories, out of which major chunk came from Carbohydrates & lesser from proteins, fats & ﬁbers. He was consuming sugars, biscuits, and white rice – basically simple carbohydrates. This showed that no caution was exercised when it came to diet and in spite of the decent food intake he was losing weight. Cause of weight loss could be attributed to continuously high blood sugars coupled with insulin resistance leading to improper utilization of the available sugar in the blood. Consequently this leads to demand, resulting in supply of energy from the muscles, subsequently causing muscle loss & in turn weight loss.

How did the Medical Nutrition Therapy help? On day 2 of admission the electrolyte imbalance was settled, blood pressure came back to normal and the sugar levels started to drop; now they were in 200’s instead of 300’s as on admission. On day 3, the sugar levels were still getting under control, Fasting: 143mg/ dL and Post Lunch: 210mg/ dL which were then monitored & given a target to be within 180mg/ dL before discharge. On taking his 3 day Hospital recall, it was observed that though he was eating lesser calories than what was prescribed, he was maintaining a small frequent meal pattern. He was taking proper foods at proper time (E.g. Fruit was being taken as a mid meal & not with a major meal).

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case study He had stopped the intake of sugar, bakery items and started taking more of fibrous foods. Hence, the medical nutrition therapy worked in helping Mr. ABC get back onto his feet, gain strength & control his sugars for a healthier life ahead. Mr. ABC was discharged on the 4th Day with controlled sugars Fasting: 90 mg/ dL and Post Lunch: 185 mg/ dL & a list of Instructions to be followed along with a Diet plan. Following are the Instructions & recommendations given to Mr. ABC: • Fruits such as apple, pear, guava, pineapple, papaya can be consumed - they have good amount of fiber so they do not elevate the blood sugar levels rapidly. Fruits such as banana, chikoo, custard apple, grapes should be avoided - since they have high caloric value. • Avoid sugar, honey & jaggery & their products, fruit juices or coconut water, potato, yam, arbi – as they have simple carbohydrates which rapidly elevate the blood sugar levels. • Consume raw vegetables in the form of salads with their peels – the fiber in them will help with supply of glucose at a steady rate. • Do not consume green leafy vegetables, soya & soya products, tobacco, alcohol or shellfishes – as the patient is on warfarin and consuming these will affect the blood density. • Bakery products such as bread, biscuit, Khari, toast, butter etc. should not be eaten – they are made from refined flour which again increases the blood sugar level rapidly. • Have chicken without skin, Fish and egg-white but avoid red meat, egg yolks & fried foods such as vada, samosa, bhajia, papad etc. as they are high in fats and this will lead to impaired cardio-vascular function and poor control of blood glucose.

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DEBUNKING Myths

exploring Facts -Anita Varier Diabetes is one of the most common metabolic disorder that is affecting humankind. We had a notion that diabetes is the disease that affects only affluent countries, but no more. Diabetes exists in all populations, irrespective of country or ethnic group. Estimates suggest that in India there will be 57 .million persons with diabetes by the year 2025 Thus the magnitude of the problem is quite high and alarming. When a person is detected with diabetes, people around readily offer advice. Taking advice from family members, friends or strangers is fine if it is scientific, but certain pieces of advice hold no truth nor are they backed by research. Hence it is necessary that we donâ&#x20AC;&#x2122;t fall for such bizarre myths and know the truth behind these misconcep.tions Here is the list of the myths that we have heard in relation to diabetes and the truth behind these myths 16 www.nutritioninsights.in

Myths and facts

Myth Sugar causes Diabetes

Fact

SUGAR

Whenever a person is diagnosed with diabetes, the first query that people ask is “Do you love to have sweets or just eat plain sugar?” Sugar is not the only factor that leads to diabetes. Diabetes is of two types: Type 1 Diabetes and Type 2 Diabetes. In Type 1 Diabetes the cells that produce insulin in the pancreas are destroyed by the immune system. Hence eating sugar is not the culprit that leads to Type 1 Diabetes. On the other hand, when the calorie intake is more than what the body needs, usually caused by intake of processed or refined foods, fatty foods or sweetened foods and beverages, we tend to gain weight and we are at increased risk of developing Type 2 Diabetes. Having diabetes does not mean that we need to cut down sugar from the diet completely. Sugar is found naturally in fruits and vegetables as well as the dairy products. The added sugar is the one that needs to be checked, like the sugar present in biscuits, chocolates, pasta sauce, baked beans, ready meals, etc. Simple modifications like having a fruit instead of biscuit or chocolate for a snack, having unsweetened yogurt with freshly chopped fruits and nuts instead of sweetened one or sticking to a few squares of dark chocolate always helps.

Myth If you are obese or over weight, you will develop diabetes.

Fact If a person is overweight or obese, it does not mean that it is a sure shot gateway towards developing diabetes; nor does it mean that the person who is of normal weight is free from Diabetes. However, people who are overweight have a risk of developing Diabetes. Overweight or obese individuals have greater pressure towards using insulin properly to control the blood sugar levels and are therefore more likely to develop Diabetes. Lifestyle modifications like healthy diet choices and control, improved physical activity levels and working towards weight control if you are overweight can bring positive results against the likelihood of developing Diabetes.

Myth Only kids develop Type 1 Diabetes

Fact Type 1 Diabetes is no longer considered as “Diabetes of childhood and adolescents”, as it was believed before. About 40 percent of the Type 1 Diabetes are diagnosed in people above 30 years of age. This misconception can sometimes be dangerous as many adults are actually Type 1 Diabetes and misjudged as suffering from type 2 diabetes and not put on insulin in order to control the blood glucose levels. It takes a longer time--almost one year-- to realize that the person who had been misdiagnosed with Type 2 diabetes is actually suffering from Type 1 diabetes and should be put on insulin. Type 1 diabetes is difficult to detect, and is wrongly misconceived in adults that majority of adults develop type 2 diabetes at later stage. One of the clue to differentiate between Type 1 and Type 2 Diabetes in adults is the failure of controlling blood glucose levels in spite of having tablets regularly. Adults in Type 1 diabetes are most likely slim as compared to type 2 patients who are obese. Hence, since with increasing age, type 2 diabetes becomes more prevalent, it makes it difficult to recognize Type 1 diabetes in adults.

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Myths and facts

Myth If you have diabetes, do not eat fruits.

Fact This is absolutely a misconceived notion. Just because fruits are sweet and contain sugar, it is advised to be avoided by diabetics. On the other hand, fruits contain natural sugars and also vitamins, minerals and fiber that always keep fruits in higher position as healthy food. Fruits fall under range of low to medium glycemic index, hence fruit consumption results in slow rise in blood glucose as compared to carbohydrate rich foods like white rice and whole meal bread. Fruits are filling as they are rich in fibre and water. Diets that contain fruits and vegetables help in reducing the risk of obesity, heart diseases, stroke and high blood pressure. Hence, it is more mandatory for people with diabetes to have fruits and vegetables. Guidelines suggest that about 5 servings of fruits and vegetables per day should be consumed. About half the plate at each meal should be filled by fruits and vegetables. One serving is one medium sized fruit whereas smaller fruits like berries have half cup as serving size. It is the preparation of the fruits that matters. Fresh or frozen fruits are better than canned or processed ones. Even dried fruits or fruit juices are processed. Fruit preparations like smoothies have high sugar levels; hence, it is better to cut down on their intake. Hence be natural, prefer whole rather than processed.

Myth I will not get diabetes as no one in my family has diabetes

Fact Yes, if you have a family history of diabetes then there is a likelihood that you can develop diabetes. However, genetics just influences the susceptibility towards developing diabetes. Even if both parents have the genes of developing diabetes and even if they are actually not suffering from it, even then you are at a higher risk. Apart from genes, it is the environmental factors like having unhealthy diet pattern and minimum level of physical activity that increases the risk of Type 2 diabetes.Though we say that even Type 1 Diabetes involves inherited susceptibility towards developing the disease, other factors like early inclusion of cowâ&#x20AC;&#x2122;s milk in infants, autoimmune condition, race and geography also play an important role in developing this condition. There have been fear and skepticism in the people who are diabetic about how to manage the condition. With the speculations that they hear around, the matter gets worse. Hence when in doubt, it is advisable to take the help of health professionals who can guide you in managing Diabetes positively and actively.

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Excercise & Diabetes

Bhoomi Shah RD, CDE, Head Nutritionist at USM

These exercises require oxygen as they use large muscle groups and are a form of intense exercises. They help to sensitise the insulin and lower the risk of heart diseases by reducing the blood pressure and improves the cholesterol. Brisk walking being the simplest aerobic exercise. Other forms are cycling, swimming, running, dancing etc. Resistance / Anaerobic exercise : These exercises also use large muscles but for short period of time hence do not require oxygen. These exercises tend to improve the muscular strength and endurance. They increase the glucose utilization in the body by making one’s body more sensitive to insulin. These exercises include weight training, push – ups, pull – ups etc. Flexibility exercises : These exercises reduces the risk of injures and are the How does exercise benefit? safest for the beginners. They reduce stress by lowering The mechanism of the role of exercise in reducing blood counter – regulatory hormones. These include simple glucose is not clearly stated. However, it can be exercises like stretching. determined that there is a raise in glucose uptake via glucose transporter 4 (GLUT4) to the skeletal muscle Exercise recommendations by ADA 2016 : during the exercise which is the accountable for reducing •Adults with diabetes should be advised to exercise for at blood sugar level people with DM. least 150 min / week of moderate intensity aerobic Exercise also activates the cell which helps to sensitise the exercises for 3 days / week with not more than 2 consecuinsulin thereby removing glucose from the blood. tive days without the exercise. egular exercise is an essential aid for optimal health but it also plays a key role in management of diabetes along with diet and medications. It also facilitates long term glycemic control as it is an alternative therapeutic regimen. There are various studies suggesting the benefits of exercise for diabetics. Benefits include – •Improved glucose tolerance as there is increased insulin sensitivity with exercise •Reduction in body weight thereby improving insulin sensitivity •Increased maximal oxygen uptake which assists to boosts the metabolism •Reduction in blood pressure, S.TG, hyperinsulinemia •Also with exercise the insulin starts to work better

Which exercise to be performed? Exercise can be broadly classiﬁed as aerobic, anaerobic / resistance and ﬂexibility. People with diabetes can follow any of these exercises as all the exercise has a positive response in lowering blood glucose levels. Aerobic exercise :

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•In absence of any contraindications, adults with type 2 DM should perform resistance training for 2 days / week. •Children with diabetes or prediabetic should be encouraged to at least have 60 minutes of physical activity daily. aged to at least have 60 minutes of physical activity daily.

Excersice with diabetes

Picture Credit : www.freepik.com

Points to remember for diabetics when exercising : •Before starting the exercise regimen always verify with the health care provider as there is ﬁne tuning needed for people with diabetes and its complications like retinopathy, neuropathy or heart disease and the exercise regimen. •Wear a medical identiﬁcation with all the necessary details so that when exercising if anything unexpected happens, it is easy to identify and solve. •Always measure blood glucose levels before exercise – blood glucose level of 100 – 250 mg / dl is the acceptable range for exercising; glucose level of 250 – 300 mg / dl indicates ketosis; ketone levels need to be checked and if they are negative exercise can be continued; glucose level of more than 300 mg / dl suggests the state of ketosis and exercise should be postponed. Blood glucose levels should be monitored after the exercise also to know if hypoglycaemia or hyperglycemia has set in. •Glucometer should be carried by one all the time. •People taking insulin should get their insulin doses adjusted as well as the site of taking insulin should be changed depending upon the muscle which is going to be exercised. •Carry some carbohydrate rich snack or some glucose tablets with one, just in case it is needed if there is any hypoglycaemic episod. •Always follow the rule of 15 as a guideline for the treatment of hypoglycemia i.e 15 g carbohydrate should be consumed, after 15 mins recheck the glucose levels, if still low consume another 15 grams of carbohydrate and recheck 15 minutes later. •During long duration and or high intensity exercise sessions, carbohydrate snacks should be taken along with

one for the activity. •Foot care must be taken; as diabetics are prone to foot infections or injuries much easier; so proper fitted socks •During long duration and or high intensity exercise sessions, carbohydrate snacks should be taken along with one for the activity. •Foot care must be taken; as diabetics are prone to foot infections or injuries much easier; so proper fitted socks and sneakers should be worn. •Hydration is another important point to be kept in mind as dehydration could lead to spike in sugar levels; so one should always keep sipping on plenty of fluids. Some easy ways to increase the physical activity include – •Walking more often i.e walking while talking on the phone. •Walking up the house – avoid lift for going up the house •Parking ones car in 1.5 – 2 kms radius to office and walking down the office. •Doing the house hold chores like cleaning, cooking, ironing clothes etc. •Playing with kids / pets in the playground. •Making own backyard gardens. •Engaging in leisure activities like cycling, swimming or dancing. Thus exercise leads to better uptake of glucose from the blood and improves HbA1C. 1.Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of exercise in the management of diabetes mellitus: the global scenario. PloS one, 8(11), e80436. 2.American Diabetes Association. (2016). 3. Foundations of care and comprehensive medical evaluation. Diabetes Care, 39(Supplement 1), S23-S35. 3.https://www.diabetesselfmanagement.com/managing-diabetes/treatment approaches/understanding-insulin/treating-hypoglycemia/ 4.Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ... & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079.

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In Conversetion with...

Kajal Bhatia is a certified Whole-Food Nutritionist with over fourteen years of experience, who pioneered India’s First Certificate Course for Plant-based Nutrition Course. She has been a Diabetes educator who empowers people to take charge of their own natural health. Her unique expertise lies in preventing and reversing lifestyle disorders like diabetes, cholesterol, weight and hormonal disorders, all with the power of food science. She is a true blue Game Changer who went back to college to pursue a full time Nutrition course after becoming a mother."Today while I reflect on the journey of KB health and eighty20, it seems to be a long one with lots of challenges on the way. Though I was an Economics graduate, I had this deep yearning to learn more about the Nutritional labels on the back of products and their impact on individual and society’s health. Post marriage and a son, I enrolled for a full-time course in Dr. BMN college to get my Bachelor’s degree in Food Science and Nutrition from SNDT University. I then went ahead to do a Postgraduate Course which certified me as a Diabetes Educator. I continued on the path with the help of my family and teachers and got more inclined to focus on natural health. That’s when my nutrition service was born. I started counselling from my home and then moved to a small garage clinic opposite my home as my son was still growing up. As the word of mouth grew, I associated with a brand called RP and started working with corporates like BCG, Dun and Bradstreet, Fullerton, etc. I also collaborated with WFWH, where we did women’s health workshops in Mumbai and Dubai. The work grew to the point of realisation that it was not diets alone but the lifestyle that needed to be sustainable to remain healthy and one needed foods on the go." -Kajal Bhatia. The Plant-based Initiative Kajal Bhatia has been a propagator and a thought leader of a plant-based lifestyle, not just to stay healthy but for its power of reversing life-threatening disorders. Apart from educating clients and those in her network, she took on to a mission of launching a certificate course for practicing Nutritionists. The certificate course has given the year 2020 the big bang start it well deserved, with Dr. Kajal Bhatia BMN College of Home Science, a SNDT University Affiliate joining forces to make Kajal’s dream a reality.

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In Converstion With... KB Health – Consultations & Seminars With a private practice of her own- KB Health, Kajal has conducted several tailored corporate seminars and healthy cooking demos. Her clients include Boston Consulting Group, Dun & Bradstreet, Fullerton India, Essar and many more. She extends her services in different formats such as nutritional consultations, healthy cooking demos, supermarket tours - and has conducted over 103 nutritional workshops in Mumbai and Dubai. Associations, Awards & Recognitions She launched a plant-based functional nutrition brand called Plant Power (earlier eighty20) that offers Plant-based protein products that are healthier alternatives to the animal-based protein products available in the market. Plant Power was nominated for the Food Start Up of the Year Award at India Food Forum 2019 and 2020. Kajal is an awarded blogger and is also a Consultant Nutritionist for the cold pressed juice brand Raw Pressery. She supported the WFWH (Women for Women’s Health) India- an initiative for women to empower their health in Mumbai and Dubai, 2015. Kajal is an active member of the IDA (Indian Dietetic Association) and the NSI (Nutrition Society of India). She was nominated for the IDA Nutripreneur Awards 2019 in the Innovative Nutrition Product Category. Media & Press Coverage Kajal Bhatia was on the panel of judges for the Health Food Challenge series on FoodFood TV Channel. She has been on panel at the Food Forum of India, 2013, 2015, 2017, 2018 and 2019. Her love for writing and education has brought to her credit various articles written bylined and published in Good Food magazine, Salt magazine, Bombay Times, Air Asia, Times of India, Mumbai Mirror among others. Kajal Bhatia’s train-the-trainer Initiative of the Certiﬁcate Course in Plant-based Nutrition was published on Vegan First and has gained popularity among many other publications.

Health trans formations Healthy cooking demos Nutritional works hops / s eminars

Changing Lifestyles! as s is t@ kajalbhatia.com/ www.kajalbhatia.com |

eighty20foods

+91 84229 84676 | Available in Mumbai, P une, B angalore, G oa, Qatar, Dubai

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Jaggery Crunch Ingredients (Serves 2-3) 250g Muesli + Cornﬂakes 150g Jaggery 1/2tsp Ghee

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Method ● Add ghee into a kadai ● Add jaggery to it and get one thread consistency. ● Once desired consistency is reached add muesli and cornflakes to it. Mix it well. Let it cool down. ● Once it cools,break it into crunches with your hands and store it into air tight container. your jaggery crunch is ready.

Food Corner Ingredients (Serves 2-3) 60g Puffed jowar 30g Roasted gram 30g Pumpkin seeds 20g Sunﬂower seeds 2no. Green chillies 10-15 no. Curry leaves 1g Turmeric powder 3g Cumin seeds 3g Mustard seeds 10g Oil 2g Salt

Method ● Place the jowar in a wide mouth pan. Roast it until it get puffed and crispy. Keep aside. ● In the same pan heat the oil and add cumin seeds, mustard seeds, garlic, curry leaves, green chillies in it. Saute until to begin to change colour. ● Then add roasted gram, pumpkin seeds and sunflower seeds in it. Saute them for a minute. Then add turmeric powder to it. Add salt for taste. ● Combine everything and finally add puffed jowar. Roast all ingredients for 4-5 minute and then turn off the heat. Let the chiwada cool completely before storing.

Jowar Chivda

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Food Corner

Makhana Paneer Chaat

Ingredients (Serves 1)

Method

½ cup Roasted Makhana (foxnuts) 50g (approx ½ cup) Paneer cube ¼ cup chopped small cucumber ½ cup Red & yellow Pepper cut into slices ¼ cup chopped tomatoes 8-10 mint leaves 1 tbsp chopped coriander 1 green chilli, cut into rings ½ tsp ginger slivers ¼ tsp red chilli powder ½ tsp cumin powder (jeera powder) ½ tsp lemon juice ½ tsp salt ¼ tsp pepper powder 1 tsp oil

● Heat the oil. In a pan and

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Method

add cumin seed, chilli and ginger. Add paneer and chopped pepper.Saute till it turns bit crunchy. ● Let the mixture cool down completely. ● Now add remaining all the ingredients and Mix well.Serve immediately.

Sheryl Salis is the Founder of Nurture Health Solutions, a true health and wellbeing company running care management programs for individuals and corporates. She is a Registered Dietician, Naturopath, Certiﬁed Diabetes Educator, Lecturer and Certiﬁed Insulin Pump Trainer.

With a career spanning twenty years, she has a rich experience in the ﬁeld of Nutrition and Metabolic Disorders, and in the past has worked with leading Multinational Hospitals and Companies like Johnson & Johnson and Novo Nordisk. Over the years, she has trained thousands of patients and healthcare professionals in Nutrition and Diabetes Management. She is an internationally acclaimed Diabetes nutrition specialist and her book on Carbohydrate Counting is referred to globally by experts and patients. She has been invited as a speaker at many National and International medical conferences and public forums. Diet in Diabetes Simplified Sheryl Salis

She is actively involved in academics being associated as a course director, faculty and a research guide to various educational institutions training healthcare professionals. She regularly features as an expert nutritionist on TV and in the print media. She has also authored several books on Nutrition. She has had the proud privilege of being selected by the Municipal Corporation of Greater Mumbai (MCGM) to develop the “Family Guide”. Her area of expertise is Type 1 Diabetes, Insulin Pump Therapy and Carbohydrate Counting.

Sheryl Salis Registered Clinical & Sports Nutritionist

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Reasearch EFFECT OF MODIFIED FOOD PRODUCT ON THE BLOOD GLUCOSE LEVEL OF TYPE 2 DIABETES MELLITUS. Abstract: Background & Objectives: Diabetes mellitus is a chronic disease caused by the deficiency in production of insulin / by the ineffectiveness of the insulin.WHO has estimated that in 2015, 1.6 million deaths were caused by diabetes. The objective of study was to modify a food product using functional foods & to see its effect on the T2DM patients. The functional foods which were used in making of the product were Betel leaf, Garden cress seeds, etc. Method and Results: Two groups were selected for the study i.e. experimental & control. 10 subjects with T2DM who were taking oral hypoglycaemic drugs were selected for each group. The modified food product was given only to experimental group for 1 month at dosage of 20gm/day. Before the intervention study standardization, shelf life study & phytochemical testing was also done on the modified product. After the intervention study a significant (p ≤ 0.05) reduction was observed in the fasting as well as post prandial blood glucose levels of experimental group as compared to the control group. Conclusion: It can be concluded that this food product might be beneficial for T2DM patients. Further studies are needed to be done since the sample size of the study was small.

SCREENING OF LIPOHYPERTROPHY (LH) IN TYPE 1 AND TYPE 2 DIABETES PATIENTS AND FACTORS INFLUENCING THIS CONDITION. Abstract : Background & Objectives: Lipohypertrophy (LH) is a chronic complication of diabetes mellitus that is caused by frequent subcutaneous injections of insulin. This study examines the prevalence of insulin-induced LH at injection sites in diabetes individual (Type 1 and Type 2), as well as the factors that have been affecting this condition. Method : The research sampling consisted of 50, OPD diabetes patients, who had been using insulin for at least 6 months. Observation and palpation techniques were used in assessing LH in diabetics' subjects. LH was assessed as present or not resent. The presence of noticeable or palpable lump at the injection site indicated that LH was present. A questionnaire was developed using relevant literature and FIT guidelines. Data were analyzed using SPSS version 16, percentages, χ2, and logistic regression analysis, chi-square analysis Results: LH was identified in 13 of 50 study participant (26%). The factors which influence development of LH are like duration of insulin therapy, needle length, frequency of insulin injection/day, insulin type. There was a strong relationship between the presence of LH with non –rotation of sites and needle reuse. Conclusion: LH was prevalent in our patients and could be because of lack of knowledge, faulty insulin injection technique. Therefore, intensive diabetes education and counselling play important role in reducing the occurrence of LH in insulin-treated patients. Key words:-Lipohypertrophy, needle length, insulin, Type 2 diabetes, site –rotation, needle reuse

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nutri Meter

Nutri

Meter

Vadapav is a popular Street food of mumbai. Also known as bombayburger,consists of deep fried potato dumpling placed inside a breadbun(pav) sliced almost in half through the middle.It is generally accompanied with one or more chutneys and a green chilli pepper.Vada comes from the Marathi compound word batatavada,which means "potatofritter".Pav is a derivative of the Portuguese word "pão", which means bread. Nutrition Facts Serving Size : 1piece(140G) Amount Per Serving Calories from Fat : 107 kcal Total Calories : 202 kcal 13.3%

26.9g

CARBOHYDRATES

25%

5.5g

FAT

21%

10.5g

PROTEIN

CHOLESTEROL

0.03%

0.069g

SODIUM

0.2%

0.405g

POTASSIUM

6.06g

VITAMIN A

2.02g

VITAMIN C

6.06g

CALCIUM

13%

26.2g

IRON

Secrets of Vadapav

Pros:

•Potato being the main ingredient is an inexpensive source of carbohydrate. •Gram ﬂour used to coat the vada is a rich source of protein. •The coriander and mint chutneys used do not contain any preservatives. •Garlic, ginger, mustard used as side ingredients not only add taste to vada pav but are also rich in ﬂavonoids. •Loaded with vitamin C and beta carotene are green chillies which are served with vadapav. •In comparison to burger version, the patty/vada is not frozen and loaded with preservatives

Cons:

•The fat content shoots up due to deep frying process. •Irrespective of the type of oil used the fat content is high. •The pav is made up of maida, instead of whole wheat bread which is void of ﬁber.

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