diet protocol for diabetes mellitus.pptx

model diet for diabetes

1. SUBMITTED TO SDMYNCH SUBMITTED BY SANJANA G DIET PROTOCOL FOR DIABETES MELLITUS

2. FOODS WHICH ARE MEDICINE FOR DIABETES MELLITUS(1&2) Bitter gourd Knol khol Fenugreek Ivy gourd Okra/ladies finger Brassica oleracea Millets (foxtail millet, finger millet ,proso millet)

3. Plant leaves ( mango, guava, insulin plant, mulberry, parijatha leaves, yekke leaf etc) Onion and its leaf Milk thistle Cinnamon Garlic cloves Green tea Cayenne pepper capsicum

4. Bitter gourd

5. Bitter gourd contains a lectin that has hypoglycemic effect. Which develops after eating bitter gourd by acting peripheral tissue and suppressing the appetite, its similar to insulin’s effect in the brain. 2000mg/day of bitter gourd significantly reduced the blood glucose level in T2DM patients(journal of ethno pharmacology jan2011). In march 2018 study bitter melon increased cellular uptake of glucose & improved glucose tolerance.

6. According to one research by Saeed MK et al & Tan MJ et al, constituents of bitter melon which are responsible for the antidiabetic effects are triterpene, proteid, steroid, alkaloid, inorganic, lipid & phenolic compounds. Momordicine 2 and 3-hydroxycucurbita-5, 24-dien-19-al-7, 23-di-O-beta-glucopyranoside were extracted as saponin form from the BM showed significant insulin activity in MIN6 beta cells (Kellar AC et al). The major compounds that have been isolated from bitter melon and identified as hypoglycemic agents are charantin, polypeptide-p, vicine.

7. Possible mode of action of M.charantia & its extracts Stimulation of peripheral & skeletal muscle glucose uptake. Inhibition of adipocyte differentiation. Suppression of key gluconeogenic enzymes. Stimulation of key enzymes of HMP pathway Preservation of islet beta cells and their functions.

8. Knol khol

9. Knol khol extract proved that it has hypoglycemic effect and antioxidant activity in diabetic rats. A researcher Andallu B noticed that Knol khol Polyphenols, tannins, ascorbic acid Significantly improved gylicemic control & also reduced the lipid peroxidation in erythrocytes(33%), plasma (21%), urine (16%)

10. A study by Dr Selvakumar showed significant reduction in blood sugar level after 120min. No immediate effect (30min) on DM Type 2.

11. Brassica oleracea A study in 2015 by Indumati sharma et al, revealed that the administration of brassica oleracea extracts in wistar rats significantly reduced FBS by 64% within 7 days of treatment. Additionally this extract was also observed normalize the diabetic rats’ lipid profile and HbA1c. Protection of kidney and liver functions also noted. The polyphenolic isothiocynates are felt to be responsible for hypoglycemic activity.

12. F enugreek

13. Fenugreek seeds are rich in soluble dietary fibers ( can slow the absorption of sugar and control its level in blood) A research on role of fenugreek in the prevention of type 2 DM in prediabetic by Arpan Gaddam et al, concluded that dietary supplementation of 10g fenugreek/day in prediabetics lower the conversion into type 2 DM. They found that it increased the b-cell function and insulin sensitivity by HOMA IR assessment. So the FBS will reduce. And proved fenugreek seeds has hypoglycemic effect on both T1 & T2 DM

14. Fenugreek seeds Soluble fiber Combines with bile TG, LDL, Cholesterol levels. Insulinotropic effect- fenugreek seeds acts as insulin secretor. 4 hydroxy isoleucine (a. a) present in fenugreek is responsible for insulinotropic action & for extra pancreatic insulin – sensitizing.

15. Ivy gourd

16. Both the leaves and vegetables are advised for diabetes mellitus. A study conducted in srilanka, “blood sugar lowering effect of coccinia grandis J Voigt: Path for a new drug for DM. In this study they noticed FBS has not effected, but PPBS reduced significantly after 1 hour and 2 hour.

17. Ivy gourd leaf Suppression of glucose-6-phosphatase Increase the activity of glycogen synthesis Partly responsible for reducing PPBS. Ivy gourd increases the glucose tolerance.

18. Ladies finger/Okra

19. Khosorozadeh M et al in 2016, proved abelmoschus esulentus has positive effect on DM. Tomoda et al. 1989, reported that okra polisaccharide possesses hypoglycemic activity in normal mice. Ramachandan et al.2013 has reported antidiabetic and antihyperlipidemic potential of okra peel & seed powder on rats. Water soluble fraction of fruit of okra is studied to check the absorption of oral glucose as well as metformin from the GI tract in the long Evan rats.

20. It showed significant reduction in absorption of glucose as studies in 24hrs fasting rats, has reported the presence of 2 major flavonoglucosides named isoqercetin and quercetin-3-O-beta-glyucopyransoyl-(1”-6”)-glucoside in okra seeds which are alpha- glucosidase inhibitors (Thankosai & Phuwapraisirisan 2013). These 2 compounds inhibited the rat intestinal sucrase, maltase and in which isoqercetin was more potent (subrahmanyam et al 2011).

21. Effect of a okra fruits on ALP, AST & ALT activities on diabetic rats were also investigated. Serum glucose levels and activities of these 3 enzymes decreased significantly after the administration of okra extract (Uraku A et al 2011). Recent study 2013 by S, et al also showed the significant effect of okra on blood sugar level and serum lipid. Okada et al 2010, indicating that okra may major role in the regulation of glucose & lipid metabolism.

22. In a study, (Sabitha et al 2011) demonstrated the antidiabetic activities of okra peel and seed extracts, 100-200 mg/kg dose in diabetic rats. Decreased in Blood glucose level, increased in body weight, decreased HbA1c, SGPT had seen.

23. Millets(foxtail , finger, proso) On diabetic mice added millet proteins can increase insulin sensitivity & reduce blood sugar level as well as TG level (Nishizaha et al 2009)

24. The millets are classified as positive & neutral & negative(not there). Positive millets has more dietary fibers (8-12.5%) compared to neutral. So for DM positive millets are well suited. Compared to other cereal crops such as wheat & maize, millets are high in nutritional content, gluten free, low GI (Abdalla et al 1998). They provide high energy, high dietary fiber, protein with balanced a.a profile, many essential minerals, some vitamins & antioxidants (FAO, 1995; Lestiene et al, 2005; Suma & Urooj 2012)

25. Foxtail millet A study - T2 DM fed with foxtail millet for 90 days showed improved glycemic control as well as other improvements (Jali et al, 2012). May be due to the presence of dietary fiber content in foxtail millet which is slowly digested & absorbed in the intestine. [ Foxtail based diabetic diet- GI is 49.54%. 80grms of this powder is given/day/patient for 90 days. ]

26. Finger millet/ Ragi A study (Shobana et al, 2010) demonstrated that ragi may help to reduce cataract when T2DM mice were fed with added finger millet seeds coat. In this experiment she also observed the reversal of hypercholesterolemia & hypertrglycerolemia associated DM. Rats also showed significant reduction in weight .

27. Proso millet A study in 2008 stated that proso millet & foxtail millets improved the HDL concentration as well as reduced insulin & plasma glucose concentration.

28. Plant leaves

29. Mango leaf Mango leaf possesses pharmacological effects, that is antioxidant, antidiabetic, antimicrobial, anticancer, anti inflammatory. A study shows mango peels & mango seed extracts had potential to inhibit alpha - glucosidase more than alpha amylase. The leaf extracts inhibited alpha glucosidase. Mango leaf extract and its active compound, mangiferin showed in vitro inhibitory potential on key enzymes involving glucose metabolism that is, alpha amylase & alpha glucosidase (Aunyachulee Ganogpichayagrai et al, 2017).

30. A previous study compared potential of mature and tender mango leaf aqueous methenolic extracts. Mature mango leaf Tender mango leaf More potential to More potential to Inhibit a-glucosidase inhibit a-amylase

31. Guava leaf Deguchi et al, demonstrated that GvEx inhibited the in vitro activities of maltase, sucrase & alpha-amylase. Wang et al, found that the aqueous leaf extract from guava leaf inhibited both sucrase & maltase activities in the small intestinal mucosa of D mice. Human trial:- Single ingestion of guava leaf tea reduced PPBG elevation at 30,90,120 min.

32. A crossover clinical trial involving 20 hospitalized patients with T2DM 160mg/dl PPBS guava leaf voglibose 143mg/dl 133mg/dl

33. Improvement of diabetic symptoms & hyperlipidemia. Ingestion of GvEx(250mg/kg/day) for 7 weeks improved T2DM , D neuropathy, significantly reduced, significant reduction in the thickness index of the glomerular measangial matrix in the kidney, HbA1c (Deguchi et al). Recently Shen et al, have reported the effect of the aqueous extract from guava leaves on T2D rats. They showed that long-term feeding of the extracts significantly reduced blood glucose level, increased plasma insulin level in an oral GTT.

34. On humans also they studied they gave 12 weeks intervention for 7 patients found significant reduction in FBS. 5 of them also showed reduction in HbA1c. Also the levels of insulin, C-peptide, HOMA-IR significantly reduced in all the subjects. Serum TG levels reduced in the subjects with hypercholesterolemia. Even they conducted study on hypercholesterolemia patients separately and got the positive results.

35. Insulin plant A study by Akhila J Shetty, effect of insulin plant ( Costus igneus) leaves on dextramethasone- induced hyperglycemia, showed significant reduction in FBS, PPBS which is comparable with that obtained from Glibenclamide. The hypoglycemic action may be due to release of insulin, insulin - sensitizing action or combination of both.

36. Caltropis gigantea/ yekke A research paper “ Hypoglycemic effect of Caltropis gigantea Linn. Leaves and flowers in Steptozotocin – induced Diabetic rats by Nanu R Rathod et al concluded that chloroform extract of Cg flowers and leaf is effective in lowering blood sugar level. According to the older evidences it may be possible that the presence of flavonol glycosides may be responsible for the observed anti-diabetic activity.

37. Parijatha leaf A study “ Hypoglycemic effect of Nyctanthes arbor- tristis leaf extract on Alloxon induced Diabetic rabbits” by Chaitali pattanayak et al. stated that presence of flavonoids has been reported in NALE and flavonoids are frequently implicated as having antidiabetic effect. The possible mechanism by which NALE brings about its hypoglycemic action may be by potentiating the insulin effect by increasing the pancreatic secretion of insulin from B-cells

38. Flavonoids of NALE + Sulfonylurea receptors in Plasma membrane of P-B-cell Closure of K+ ATP channels Membrane depolarization Stimulation of Ca++ influx Promote insulin secretion.

39. The findings suggests that flavonoids in the plant extract may regenerate the damaged B-cells & increased insulin sensitizing. However NALE (400mg/kg) was not able to restore the blood glucose level to the baseline value. So it indicates that it can be used as a alternate medication with hypoglycemic diet or antidiabetic drugs.

40. A research on “ Hypoglycemic & Hypolipidemic activation of aqueous extraction of flower from Nyctanthes arbor- tristis in male mice”, by Bramanaga Sachini Rangila et al, concluded that results of this study indicated that AEF possess hypoglycemic & hypolipidemic properties. Therefore AEF could be used as an alternative medicine in management of DM. The hypoglycemic activity observed in present study can be attributed to presence of flavonoids iridoide 6 beta- hydroxylonganin in parijatha flowers.

41. AEF had a gummy viscous appearance which suggested process of fiber (Agnihotri MA et al) In vitro study had confirmed. Glucose bonds + dietary fibers (even low glucose level) Bound glucose are incapable of binding to specific transport protein for transportation This inhibit the glucose uptake from GI tract.

42. This inhibition of the glucose uptake from GI tract may be also due to improved intestinal Na+ - glucose- co- transporter as reported with synthetic phlorizin derivatives (flavonoid). AEF also showed α -amylase inhibiting activity.

43. Mulberry leaf

44. Mulberry leaf reported to be anti hyperglycemic, anti hyperlipidemic. A study by Yao Sheng et al, showed that mulberry leaf decreased the FBG and HbA1c, ameliorated the blood lipid levels and improved the insulin sensitivity in rats. They stated that flavanols and polyphenols in it are responsible for anti diabetic activity.

45. A study named “Influence of Mulberry leaf extract on the blood extract on the blood glucose & breath hydrogen response to ingestion of 75g sucrose by T2 DM & control subjects” By Mitchell Mudra et al.stated that co- ingestion of mulberry extract with 75g sucrose significantly reduced the increased blood glucose observed over the initial 120 min of testing in control & T2 DM subjects The mulberry – induced reduction in blood glucose presumably reflects the ability of mulberry to inhibit intestinal sucrase. The increased H2 observed with mulberry indicates that this supplement induced sucrose malabsorption.

46. Milk thistle

47. Christos E et al, in his paper “ The therapeutic potential of Milk Thistle in diabetes” concluded that milk thistle contain flavonoids like Silbin A an isoform of silbin , isoform 3 has been demonstrated to possess partial PPAPɣ agonist effects. Silbin has also demonstrated beneficial effects on several diabetic complications including diabetic neuropathy, d nephropathy etc. The mechanism behind this is-

48. Glucose Sorbitol Prevention of tissue damage Hence the treatment for cataract/ D neuropathy. Researchers also showed silbin decrease dihydroxyacetone (DHA) gluconeogenesis by 33% & also decrease glycolysis. Furthermore silbin inhibits glucose-6-phosphate. But no effect on fructose pathway. Aldose reductase (in organs which are not dependent on insulin for glucose transport Silbin inhibits

49. Capsicum

50. A research paper by Zhang S, et al 2017 “ Capsaicin reduces blood glucose by increasing insulin levels & glycogen contest better than capsiate in streptozotocin – induced diabetic rats”. In this study they investigated which flavonid in these 2 are having hypoglycemic action. Both increased glycogen & inhibited intestinal absorption of glucose. But the capsaicin increased the insulin levels too

51. Cayenne pepper

52. It is also having hypoglycemic effect due to the presence of capsaicin. Scientists at mahidol university in 2013, Thailand investigated the effect of chili pepper on plasma glucose levels & metabolic rates in healthy Thai women. Scientists observed that those in the chili pepper group had significantly lower blood glucose levels, 30 min after ingestion compared with those who didn’t have chili pepper.

53. Cinnamon

54. A paper by “Cinnamon improves glucose and lipids of people with Type 2 Diabetes” by A lam Khan et al. concluded that intake of 1, 3, or 6g of cinnamon/day reduces serum glucose, triglyceride, LDL cholesterol & total cholesterol in people with T2D and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cvs disorder. Extracts of cinnamon activated glycogen synthase , glucose uptake, and inhibited glycogen synthase kinase-3beta.

55. Extracts of cinnamon also activated insulin receptor kinase and inhibited dephosphorylation of the insulin receptor, leading to maximal posphorylation of insulin receptors. All there increased the insulin sensitivity. A study by Justin A et al. “ The effect of Cinnamon on A1c Among Adolescents with Type 1 Diabetes”. Concluded that cinnamon is not effective for improving glycemic control in adolescents with T1D.

56. Garlic

57. A study “ effect of garlic supplement in the management of T2DM: A meta analysis of RCT”, By Juan Wang et al. states that the antidiabetic effect of garlic reported in the studies would be concluded as rapid & sustained mechanisms and among the form of garlic allicin - a major bioactive compound found in T1D animal studies. The rapid effect of insulin secretion as well as release from pancreatic beta cells.

58. Song et al. reported that C- peptide in garlic group was significantly higher than baseline & control later. C- peptide & insulin are both secreted by beta-cell & they come from a same precursor: proinsulin.

59. Green tea

60. There was a study “ Effect of green tea on blood glucose levels and serum proteomic patterns in diabetic mice and on glucose metabolism in healthy humans” by Tsuneki et al. This study provides evidences that green tea has antidiabetic effect. Here they found that after administration of green tea the serum proteins decreased hence decreased the diabetic state. This is the first report demonstrating that a certain serum proteins may be involved in the antihyperglycemic effect of green tea. They also proved green tea increases glucose metabolism

61. Role of fruits and vegetables

62. Mohammad asif did study on this. Some good things in fruits & vegetables are vitamins, flavanoids (antioxidants), saponins, polyphenols, carotenoids, isothiocynates, dietary fibers. Reduces inflammation. The American Diabetes Association advices that any fruit is fine to eat for a person with diabetes. A meta- analysis published in 2014 in the British medical journal found higher fruit intake was significantly associated with a lower risk of T2DM.

63. Fresh & frozen fruits are better than processed include dried fruits & fruit juices. In fruit juices the dietary fibers are removed. While processing the fruits it loose its vitamins and some of key nutrients. Many fruits are filling because of their water contents and high fibers so reduce the risk of obesity and hence T2DM. The united states guidelines recommended that people fill half of their plate with fruits and vegetables. On one serving medium sized one fruit , if small fruits one bowl, ½ if processed (juice), 2 table spoon if dried fruits.

64. Glycemic index

65. While making the diet protocol for diabetic easy way to select the foods is. Select low glycemic index food Diabetes means chapathi is not a only one option 2 varies of vegetables and 3 varieties of fruits atleast should be there. Calories must range from 1500-1800/day . 60:20:20= carbs : proteins : fat.

66. week 7am 8am 8:30am 10 /11am 12:30/1:30pm 2/3pm 5/6 pm 7/8 pm Optional either L or D MON AGJ Grapes Ragi ganji / indly+BV BW /cu Foxtail millet +BV+fruits(F)+BM ½ MJ Nuts and seeds Chapathi+BV+BM/SP Fruit salad TUS AGJ Apple Idly+BV BW /cu Methi rice+ BV+F+BM/SP ½ KKJ Nuts & seeds Ragi dosa+ BV+BM/SP Slimmer salad WED AGJ guava Dosa + BV BW /cu Ragi ball/ rotti+ F+BM/SP ½ MMJ Nuts & seeds Chapathi+BV+BM/SP Super salad THU AGJ ½ mango Kichadi with more vegetables BW /cu Proso millet + BV+ F+ BM/SP ½ KKJ Nuts & seeds Foxtail dosa+BV+BM/SP Summer retreat FRI AGJ banana Any millet item+ BV BW /cu Pulav+pachadi+F+BM/SP ½ OJ/ LHJ Nuts & seeds Chapathi+BV+BM/SP Plantain pith salad SAT AGJ mm Upma/ poha BW /cu Broken wheat+BV+F+ BM/SP ½ KKJ Nuts & seeds Proso dosa+BV+BM/SP Carrot apple salad SUN BGJ Musambi /Oren Brown rice shavige/ BBB BW /cu Rice+BV+F+ BM/SP ½ PPJ Nuts & seeds Chapathi+BV+BM/SP Knol khol salad