DIETARY MANAGEMENTS OF TYPE 2 DIABETES IN PATIENTS
CHAPTER ONE
INTRODUCTION
Background of the Study
Food is any substance consumed to provide nutritional support for an organism. It is very vital to human survival. It is basis for averting hunger, satisfying one’s palate and health maintenance of every human being. it is used as a status symbol, making people, emotionally happy and socially content, and constitutes a form of cultural expression. Food is also used in the performance of rituals and rites as for therapeutic purposes. Culture has a lot of influence on the kind of food people eat and how they eat them. Indigenous diets are foods from the natural environment, which become included in the cultural use patterns of a group of indigenous people. Without the help of processed products (FAO, 1987’ Kuhnlein and Receveur, 1996; Trimigno et al; )2015). These indigenous foods not only provide much needed nutrients and dietary diversity, but can also help the communities that depend on them thrive. Most of the indigenous foods in Southern Nigeria, are from plant food sources, which have many health- enhancing bioactive constituents.
Plant foods also remain the major source of nutrient for large population of the world. They are available, affordable and acceptable. Studies show that plant food contains many chemical compounds needed for metabolic functions in varying proportions (Schieber et al., 2001; Truchado et al., 2015). Some of these chemical compounds are non-nutrients that are beneficial to man while, other provoke some adverse reactions depending on the level of intake, interrelationship with nutrients and food habits (Bennet and Prince, 2009; Udenta et al; 2014).
Plant foods are classified as cereals, roots and tubers, legumes (Pulses, oil seeds and nuts), Fruits and vegetables (Osagie and Eka, 1998). They are abundant and contain varying levels of the macronutrients (carbohydrate, proteins, fats, and water), micronutrients (minerals and vitamins) as well as non-nutrients (dietary fiber, phytochemicals and antioxidants) (Thomas, 1994). These constituents or components of plant food have health-promoting qualities. People like to combine different plant food sources in order to achieve maximal health benefits. Africans were hither to known for healthy, wholesome and nutritious traditional foods.
Within the last few decades, there is growing interest in reviving the health-promoting potentials of indigenous plant foods in developing countries and integrating their use into modern medicine (Liu, 2013). Some of the reasons for this interest include; (i) the negative impact of nutrition transition that increase the epidemic of diet-related no –communicable Diseases (NCDs) in such regions. Diet-related NCDs among which is diabetes mellitus types 2 (DM), are disease of long duration and are generally slow in progression. They are relative difficult to manage, involved high cost of medical care, which put modern health care out of the reach of the poor and poor adherence to drug prescription (WHO, 2009).
Diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism, resulting from defect in insulin secretion or action or both. Nutrition is important in diabetes mellitus as it is involved in the aetiology or in the management of diabetes mellitus. Nutrition for people living with diabetes can be divided into prevention and continual management of glycemic control. According to Fazia (2015), the goals of nutrition in prevention which, involves the identification of the population at high risk (body mass index (BMI) greater than 25), obesity or prediabetic state and implementation of diet and lifestyle changes. The second one, involves the utilization of nutrition as a therapeutic modality to achieve euglycemia in diabetic individuals, while the third also known as tertiary prevention uses nutrition as a tool to manage the macrovascular and microvascular complications of diabetes and delay morbidity and mortality.
In USA, recent nutritional guidelines specifically targeting people with type 2 diabetes was presented by the Joslin Diabetes Center, Massachusetts, USA (ADA, 2017). These guidelines are based on available food substances in the U.S. Today, there are many forms of diets being consumed, especially in the developed world, Asia and parts of Africa. These diets sometimes necessitate lifestyle changes and include, but not limited to Mediterranean diet, Raw- food diet, Vegetarian diet, Vegan diet, Weight whatchers diet, ketogenic diet, Zone diet, Atkins diet, South beach diet (Burkert et al., 2014).
The Mediterranean Diet; is of South European origin, it emphasizes more of plant foods, fresh fruits as dessert, beans, nuts, whole grains, seeds, olive oil as the main source of dietary fats. Cheese and yogurts are the main dairy foods. This diet also includes moderate amounts of red meat, and low to moderate amount of wine. About one-third of the Mediterranean diet consists of fat, with saturated fats not exceeding eight percent of calorie intake. It is a diet known to be low in trans fats and free from refined oils and highly processed meats and foods (Giugliano and Esposito, 2018). The Mediterranean diet is the most extensively studied diet to date, with reliable research supporting its use for improving a person’s quality of life and lowering disease risk. (Sofi et al, 2010).
The Ketogenic Diet, this involves the reduction of carbohydrate intake and increasing of fat intake (Fife, 2017). Healthy fats such as those in avocados, coconuts, Brazil nuts, seeds, oily fish and olive oil are liberally added to the diet to maintain an overall emphasis on fat. The diet causes the breakdown of fat deposits for fuel and creates ketones. The risks associated with this diet includes ketoacidosis for people with type 1 diabetes and may result to diabetic coma and death. There are some promising research in relation to diabetes management, metabolic health, weight loss and body composition changes (Azar, 2016).
The Zone Diet; encourages the consumption of high-quality unrefined carbohydrates and fats. It aims at a nutritional balance of 40% carbohydrate, 30% fats and 39% protein in each meal, the precise 0.75 protein to carbohydrate ratio required in zone diet meal is promoted in order to reduce the insulin to glucagon ration (Cheuvront, 2013). Most of these diets are being used in developed countries in the management of diseases among which is diabetes and diabetes related diseases.
However, in sub-Saharan Africa (Nigeria as case study), there are documented dietary guidelines such as National Guidelines for the Prevention, Control and Management of Non- communicable Diseases in Nigeria, by Federal Ministry of Health Nigeria, among others, which provides guidelines for dietary management of diabetes. Studies so far conducted include, Gbolade (2009), inventory of anti-diabetic plant in the traditional management of diabetes in Nigeria: pharmacological and toxicological consideration; Ogundip et al., (2003), hypoglycemic potentials of methanolic extracts of selected plant foods for human and; Udenta et al., (2014) anti- diabetic effects of Nigeria indigenous plant foods/ diets etc.
DIETARY MANAGEMENTS OF TYPE 2 DIABETES IN PATIENTS
