‘Old Is Gold’: How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management

Abstract

Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families struggle to find ways to provide nutritious, yet attractive, food with a low glycemic index (GI). India is one of the oldest continuous civilizations with a rich and diverse cultural and culinary heritage. Traditional dietary practices, including the centuries-old ‘Thali’ (meaning plate) concept, emphasize combinations (grains, lentils, vegetables, dairy, spices, prebiotics and probiotics, and fats) of local, seasonal, and predominantly plant-based ingredients. These practices ensure that all of the necessary food groups are provided and fit well with current evidence-based recommendations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 Guidelines. Techniques for the preparation, cooking, and preservation of food further impact the GI and nutrient availability. These practices benefit nutrient density, diet diversity, and palatability and thus improve adherence to meal plans and glycemic control. This narrative review describes the ancient wisdom, food composition, and culinary practices from across India which are still valuable today. These may be of benefit worldwide to improve glycemic control as well as quality of life, especially in PwD.

Reliability and Structure of Diabetes Diet Adherence Scale (D-DAS): A Follow-up Study among Type 2 Diabetes Patients of India

“…Another meta-analysis suggests that whole grains positively impact glucose metabolism [20]. However, the food processing and preparation method was important to maintain the structural integrity of the whole grains [21, 22]. Working groups from India, including the Indian Council of Medical Research (ICMR) and the Research Society for the Study of Diabetes in India (RSSDI), have framed treatment recommendations for diabetes using nutritional principles.…”

Cultural Adaptations Addressing Diversity and Health Access in the Mediterranean Diet: A Realist Synthesis

“…41 Researchers explained that traditional South Asian dietary paradigms include a wide variety of lentils, which are a great source of fibre and low in fat, helping to regulate blood glucose levels, and such foods consumed by South Asians in Western countries led to significant delays in the development of hyperglycemia, hyperinsulinemia, dyslipidemia, glucose intolerance, and oxidative stress. 42,43 When glycemic responses were tested in South Asian individuals consuming traditional grains rather than Western grains, it was found that glycemic response to pearl millet (bajra) and barley, but not corn, was significantly lower than the glycemic response to white bread. 44 Research into why South Asian populations have such a high prevalence of unmanaged diabetes found that patients were not receiving diabetic diets customized to the traditional South Asian dietary paradigm, which decreased adherence to the prescribed diets.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings

“…Rather than providing fixed diet charts, practical modifications of pre-existing dietary patterns promote acceptance and psychological well-being. 67 The meals of a PwD are essentially healthy meals and the entire family should eat the same food. Some PwD in LRS live in close proximity with multiple relatives, sometimes sharing a kitchen.…”

“…Local traditions, food culture, and food availability have to be assessed. Rather than providing fixed diet charts, practical modifications of pre‐existing dietary patterns promote acceptance and psychological well‐being 67 . The meals of a PwD are essentially healthy meals and the entire family should eat the same food.…”