Gagan Priya ( Department of Endocrinology, Fortis Hospital, Mohali, India. )
Emmy Grewal ( Departments of Endocrinology Ivy Hospital, Mohali, India )
Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Desserts form an important and integral part of South East Asian cuisines and are often associated with festive eating and celebrations. Since most desserts are high in caloric content and contain refined carbohydrates and saturated or trans-fats, their consumption poses obvious challenges in diabetic individuals. Meals should not only meet the biological needs of an individual but should also be palatable, appealing and retain their hedonistic aspects of taste, smell and visual appeal. While remaining within the principles of medical nutrition therapy, desserts can be incorporated into meals with use of whole grains, low fat dairy or yoghurt, fruits, vegetables and pulses as their primary ingredients. Intake of free sugars can be minimized by using non-nutritive sweeteners, soluble fiber, condiments and spices. In this article, we focus on ways to encourage healthy eating among diabetics while still retaining pleasurable foods such as desserts.
Keywords: Desserts, healthy desserts, nutrient-dense food, festive eating, diabetes.
Desserts include a sweet course usually served at the end of a meal. For long, desserts have been associated with celebrations and festivities and feasting is considered incomplete without the sweet servings. This is particularly true for South East Asian cultures including India, which was home to the invention of refined sugar granules from sugarcane juice approximately 2000 years ago.1 In fact, the word 'sugar' has its origin from Sanskrit 'Sharkara' and its vernacular 'Shakker' that was later adapted as 'Shakar' in Arabic. It was from South Asia that the use of cane sugar spread to the rest of the world. In the medieval period, sugar was expensive and was considered a fine spice and synonymous of fine dining, till large scale industrial production began later. Since long, sweets have formed an integral component of South Asian cuisine and were considered worthy of foods served to the Gods.
Desserts and Medical Nutrition Therapy
The prime focus of medical nutrition therapy (MNT) in diabetics is to promote and support healthy eating patterns, emphasizing on a variety of nutrient-dense foods, in appropriate portion sizes to improve overall health. However, while food consumption primarily serves a homeostatic purpose for the body, i.e. maintenance of adequate energy stores and nutrient requirements, the hedonistic aspects of eating cannot be overlooked.2 Adherence to medical nutrition therapy is highly unlikely if it is not palatable and pleasurable. Food should not only meet the biological requirements of an individual but should be socially and culturally acceptable and psychologically appealing in terms of visual appeal, taste and flavor. The problem with most desserts is that they are high calorie foods with high content of simple sugars and saturated or trans-fats, are not nutrient dense and do not promote satiety. Therefore, they pose an obvious problem for individuals living with diabetes and have often been considered the Forbidden Fruit. However, contrary to popular belief, desserts can be incorporated into the meal planning of diabetic individuals by modifying their composition to include nutrient-dense ingredients while preserving the hedonistic features of taste, texture and appearance.5
Table 1 enlists some principles which can guide dessert planning for diabetics.
Characteristics of a Healthy Dessert
A healthy dessert, if created thoughtfully keeping in mind the core principles of MNT, can be incorporated into a balanced meal by utilizing ingredients from various food groups including cereals, pulses, dairy, fruits and even vegetables. The strategies that be utilized to satisfy the sweet tooth while still retaining the nutritive value of food and avoiding glycaemic excursions include the following:
1. Choice of main ingredient – desserts based on fruits, complex cereals/ whole grains, pulses, low fat dairy,7 vegetables.
2. Healthy Cooking Techniques - baking, steaming, freezing, roasting.
3. Non-nutritive sweeteners - Non-nutritive sweeteners can be used in place of sucrose, such as sucralose, stevioside or aspartame.8 In addition, addition of soluble fiber such as amylase-rich starch and dextrins has also been associated with les s pos tprandi al gl yc aemic excursions.8 A small amount of simple sugar when added to a mixed meal occasionally has not been associated with wors ening of glyc aemic control.4 However, use of sugars should be minimized9 Spices and condiments that minimize the use of sugar and enhance flavour - cardamom, cinnamon, nutmeg, saffron, vanilla, ginger, black pepper, red chilli, dried fruits, dates, citrus, raisins, nuts.
5. Foods rich in Prebiotics - prebiotics include dietary fiber that is fermented by intestinal bacteria and stimulates growth and activity of intestinal microflora. These include inulin and fructo-oligosaccharides, wheat dextrin and polydextrose.3 Desserts based on fruits, whole grains and yoghurt can be a good sourceof prebiotics.
6. Portion control - Use smaller serving plates or bowls along with smaller forks and spoons for desserts. When consuming desserts as a part of a meal, it should be exchanged for another food serving keeping in mind the caloric and macronutrient balance of the meal. e.g. Yoghurt or dairy-based dessert can be substituted in place of curd, cereal-based dessert should be substituted in place of a regular serving of cereal.
7. Presentation and appeal - decorating desserts with fresh fruits, nuts and raisins increases their visual and olfactory appeal.
Dessert Planning in Diabetics
Some of the main ingredients that can be used to cook nutritious desserts include fruits, vegetables, cereals, pulses, low fat dairy such as yoghurt or cheese and dark chocolate. These are enlisted in table 2.
Food consumption in individuals living with diabetes does not have to be a mundane, puritanistic ritual. Desserts should no longer be considered forbidden in diabetes. The pleasure of eating desserts can be retained with the use of nutrient-dense ingredients from various food groups and cooking styles that lead to less glycaemic excursions or other metabolic abnormalities. Whole grains, fruits, vegetables and low fat dairy-based desserts can be modified to retain their nutritive value and still satisfy the senses.
1. The Sugar Industry. Nature 1930 Feb; 125:255. Available at https://www.nature.com/articles/125255a0.pdf. Cited on 10 June 2018
2. Saper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002; 36:199-211.
3. Morais EC, Morais AR, Cruz AG, Bolini HM. Development of chocolate dairy dessert with addition of prebiotics and replacement of sucrose with different high-intensity sweeteners. J Dairy Sci. 2014; 97:2600-9.
4. Buysschaert M, Sory R, Mpoy M, Lambert AE. Effect of the addition of simple sugars to mixed meals on the glycemic control of insulin treated diabetic patients. Diabete Metab. 1987; 13:625-9.
5. Webb R. Healthy eating. Delectable desserts. A not-so-guilty pleasure. Diabetes Forecast. 2007; 60:40-2.
6. El Khoury D, Brown P, Smith G, Berengut S, Panahi S, Kubant R, Anderson GH. Increasing the protein to carbohydrate ratio in yogurts consumed as a snack reduces post-consumption glycemia independent of insulin. Clin Nutr. 2014; 33:29-38.
7. Argiana V, Kanellos P?, Makrilakis K, Eleftheriadou I, Tsitsinakis G, Kokkinos A, et al. The effect of consumption of low-glycemic-index and low-glycemic-load desserts on anthropometric parameters and inflammatory markers in patients with type 2 diabetes mellitus. Eur J Nutr. 2015; 54:1173-80.
8. Argyri K, Sotiropoulos A, Psarou E, Papazafiropoulou A, Zampelas A, Kapsokefalou M. Dessert formulation using sucralose and dextrin affects favorably postprandial response to glucose, insulin, and Cpeptide in type 2 diabetic patients. Rev Diabet Stud. 2013; 10:39-48.
9. Kalra S, Kalra B, Gupta Y. Reduce free sugars for a healthy life. Journal of Medical Nutrition and Nutraceuticals. 2015;4:3.
10. Sharma R, Kumar KH, Kalra S. The ominous octet of "S" innoncommunicable disease. J Soc Health Diabetes. 2017;5:12