Discussion

In our study the preparations from millets and whole grains like broken wheat upma, corn puttu, wheat dosa and ragi dosa showed a better glycemic response when compared with rava upma, puttu and dosa due to low glycemic index in the high fiber preparations of Kerala cuisine.

Oats upma had a better glycemic response than semolina upma as the fiber content in oats is higher than semolina. Also the particle size of oats is bigger than semolina which contributes to a better glycemic response. Diabetic individuals can benefit from diets that are high in(β-glucan, which, as a component of oats) [10].

Broken wheat upma had a significant difference compared to semolina upma. Broken wheat and other whole grains are good sources of magnesium. This mineral is essential to more than 300 enzymes, especially those that contribute to insulin secretion and the release of glucose into the bloodstream. The risk of developing type II diabetes can be up to 30 percent lower in people who consume cracked wheat and other whole grains regularly.

The preparation with millets had a good glycemic response. The millet based diet lowered HbA1c (19.14%), fasting glucose (13.5%), insulin (1.9%) concentrations, total cholesterol concentrations (13.25%), triglyceride concentration (13.51%) and very-low-density lipoprotein cholesterol concentration by 4.5% in the patients with type 2 diabetes [11]. In our study, wheat dosa had a better glycemicresponse compared to dosa made of rice flour and black gram. New research confirms that refined grains, like white rice, pasta or breads, are linked to increased rates of metabolic syndrome, a predictor of both cardiovascular disease and type II diabetes. Metabolic syndrome is far more common in people who eat refined grains instead of whole grains. Cracked wheat and other whole grains decrease the rate of metabolic syndrome when added to a daily diet [12].

Over the past decades, the state of Kerala has witnessed a substantial increase in the prevalence of diabetes mellitus and other non-communicable diseases. This is because of the shift in the consumption pattern of Kerala foods from low cost whole grain cereals to high glycemic index foods. Dietary management is an indispensable tool for the control of glycemia and prevention of complications of diabetes glucose. Since foods with low GI caused significantly lower post prandial glycaemic response, they are considered better for people with diabetes. It has been demonstrated by several researchers over the past decades that consumption of foods having lower glycaemic response and the higher unavailable carbohydrate diets are associated with reductions in body weight, improvement in glycemic control and insulin sensitivity [6]. It has also been shown that low GI diets are associated with reduced risk of type II diabetes and cardiovascular disease [7,8]. GI has become an important tool for helping people select the right food to stabilize blood sugars [9].

The results in our study show that high fiber cereal preparationsof Kerala cuisine had higher satiety similar to a study by M. Bacardi-Gascon with low GI foods [13]. As in our study Ludwig observed 53% and 81% lower food intake after low GI breakfast and lunch respectively, when compared to the intermediate and high GI foods[14].

In a pilot study un published data six healthy subjects ate a 420-calorie breakfast bar after an overnight fast, and then at lunch were offered an all-you-can-eat buffet. When subjects ate a barley bar at breakfast they subsequently ate 100 calories less at lunch than whenthey ate a traditional granola bar for breakfast. Barley high in betaglucan fiber may digest more slowly than standard barley varieties. Researchers at USDA and the Texas Children’s Hospital (TCH)compared the two and concluded that barley may indeed be especiallyappropriate for obese and diabetic patients. These results were similarstudy where the satiety and glycemic response was better with barley upma. Similar to our study, USDA researchers fed barley flakes, barleyflour, rolled oats, oat flour, and glucose to 10 overweight middle-agedwomen, then studied their bodies’ responses. They found that peak glucose and insulin levels after barley were significantly lower than those after glucose or oats. Particle size did not appear to be a factor, as both flour and flakes had similar effects [8].

Holt did not find an association between glucose AUC and satiety scores [9]. Stubbs and Cols (2001). pointed out that more than 26 studies have shown that complex carbohydrates have the highest effect for reducing hunger and limiting the subsequent consumption of energy [10]. In the study conducted by Buyken and cols. an association was observed between low GI foods, with low A1C [11]. In our study the effect on satiety was attributed to the consumption of carbohydrates and fiber. Our results suggest that inclusion of high fiber cereals in Kerala preparations increases the perception on satiety and might be a low cost approach for the control of diabetes [15].

This is the first study in India which has studied the glycemic response of the traditional and healthy preparations of Kerala cuisine.Dietary intervention was focused on the intake from local low-costresources such as nutritionally rich millets, legumes/lentils, and whole grains. Moreover this research recommended foods that are locally available, which provided a better glycemic control.

These data thus provide information helpful in the design of diets for people with diabetes which contain unrefined carbohydrates in a form which is digested and absorbed slowly. However, food culture and preference would still need to be considered [16].