Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India; University Center for Research & Development, Chandigarh University, India. )
Maïmouna N. Mbaye  ( Department of Internal Medicine, Directrice du Centre national du diabète Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal )
Sédrick Ahomagnon  ( Department of Endocrinology, Clinique d'Endocrinologie-Diabetologie St PIO, Cotonou, Benin Republic )
Joel Teelucksingh  ( Department of Endocrinology, San Fernando General Hospital, San Fernando & Department of Endocrinology, Central Specialist Medical Centre, Chaguanas, Trindad & Tobago )
Shahjada Selim  ( Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh )
Shilpa Joshi  ( Department of Dietetics, Mumbai Diet and Health Centre, Mumbai, India. )
Hilda Nabiswa  ( Department of Medicine, Meridien Hospital, Nairobi, Kenya )

Rice, or Oryza sativa/ Oryza glaberrima is the largest sources of carbohydrates, and calories, for mankind. It is the staple food across many countries of America, Africa and Asia. Hence, we need gluco-friendly ways of incorporating rice-based menus into the cuisine of persons living with diabetes. This multinational article discusses this challenge, and highlights the importance of informed and shared decision making with persons living with diabetes.

 

Keywords: Diabetes, glycaemic index, medical nutritional therapy, Oryza sativa, obesity, person-centered care, rice, type 1 diabetes, type 2 diabetes.

 

DOI: 10.47391/JPMA.23-18

 

Introduction

 

Rice is the most widely used staple food in the world, and has the third highest yield of all agricultural crops, after sugarcane and maize. One fifth of all calories consumed by mankind are in the form of rice. ^1,2 Being one of the most economical staple foods, it forms a major  part of the diet in low and middle income households. Rice is associated with a high glycaemic index, and hence its use is discouraged in persons with diabetes. This approach, however, is not concordant with the person-centered philosophy of modern diabetes care, especially medical nutrition therapy.³

 

The Diversity Of Rice

 

Rice itself is not a homogenous entity. Usually the seed of Oryza sativa (Asian rice), it may be used to refer to Oryza glaberrima (African rice) or Zizania and Portersia (wild rice). Rice can be classified as long-, medium-and short-grained. Long-grain rice contains more amylase, while medium-grain varieties are rich in amylopectin. Though usually white, rice can be red, brown, black or purple, too.

Rice may be fortified with vitamins and minerals. It can be rinsed or soaked to reduce starch, and decrease cooking time as well as fuel usage. Cooking can be done by boiling, steaming or frying. The cereal can be used as a solo dish, as part of soups, puddings and porridges, as a bread, cake, and as wine as well.

Rice contains 91% carbohydrates and 8.1% protein, with negligible fat. Nutrient content depends upon the colour of the rice, the quality of the soil that the crop is grown in, the style of polishing, processing, preparation and preservation.⁴ It is mandatory, though, to add other foodstuffs from other food groups to a rice-based meal, to ensure nutrient adequacy.

 

The Utility Of Rice

 

Keeping this diversity and the needs of persons living with diabetes in context, it seems rational to explore various ways of including rice in their diet, in a gluco- friendly manner. In this communication, we share simple ways of incorporating rice in daily diet, without affecting glycaemic control of persons living with diabetes, while ensuring balanced intake of macro and micro-nutrients. We do so use a hierarchal framework of culinary medicine: procurement, preparation, presentation and plating of rice. We attempt to create a structured list of ways in which the glycaemic load and glycaemic index of rice can be minimized, and its nutritional shortcomings mitigated.^4,5 (Table 1)

 

 

The Conversation About Rice

 

Culinary skills are an essential part of diabetes care providers skills.⁶  However, these do not translate into good glucose control, unless accompanied by proper counselling and support.

 

 

Table 2 uses a BALANCE-RICE approach to describe the components of rice related nutritional counselling. A discussion about the need for a balanced diet, the advantages and limitations of rice, as well as novel ways of overcoming the shortcomings is mandatory with every rice-eating person. One should be able to offer the right degree of engagement and reassurance, interacting with family members and other care givers who are involved in meal planning and cooking. The community and society at large must be sensitized to the needs of persons with diabetes, and requested to avoid “culinary cruelty” (forcing persons with diabetes to consume unhealthy foods) and “dietary draconism” (preventing person with diabetes from eating their preferred foods in appropriate quantities).⁷ .

 

Summary

 

We acknowledge that the diversity of rice-based cuisine is too vast to be included in one communication. As oryzovorous endocrinologists from across the world, we-feel that this structured communication should kickstart a person-friendly, and gluco-friendly, dialogue on how to incorporate rice in the diet of persons who prefer this staple food

 

References

 

1.      Fukagawa NK, Ziska LH. Rice: Importance for global nutrition. J. Nutr. Sci. Vitaminol. 2019;65(Supplement):S2-3.doi: https://doi.org/10.3177/jnsv.65.S2

2.      Mohidem NA, Hashim N, Shamsudin R, Che Man H. Rice for Food Security: Revisiting Its Production, Diversity, Rice Milling Process and Nutrient Content. Agriculture. 2022;12:741.

3.      Viswanathan V, Krishnan D, Kalra S, Chawla R, Tiwaskar M, Saboo B, et al. Insights on medical nutrition therapy for type 2 diabetes mellitus: an Indian perspective. Adv. Ther.. 2019;36:520-47.

4.      Boers HM, Seijen Ten Hoorn J, Mela DJ. A systematic review of the influence of rice characteristics and processing methods on postprandial glycaemic and insulinaemic responses. Br. J. Nutr.. 2015;114:1035-1045.

5.      Ahmad SR. Foods Consumed with Rice that Elicit a Reduction in Glucose Response among Healthy Individuals. Curr Res Nutr Food Sci 2020; 8. doi: http://dx.doi.org/10.12944/CRNFSJ.8.2.28

6.      Kalra S, Choubey N. Involving culinary science as part of the diabetes care team. J Pak Med Assoc. 2017; 67:1795-6.

7.      Kalra S, Joshi S, Das S. Culinary happiness. J Pak Med Assoc. 2021;71: 1902-1903.