• Moloya G.

Diabetes diet: Can we include rice in our meal?

For us- born to love rice - it is tough to be forced to go in for alternatives due to diabetes. It seems the satiety of our life never comes to us. However, much we eat other foods, without seeing a bit of rice on our plate, doesn’t seem to give that “feeling of content”.

Diabetes is a condition in which the body has a problem producing or using insulin. As a result, the body does not store or use blood sugar, or glucose, effectively. If you have diabetes or prediabetes, your doctor will likely recommend that you see a dietitian to help you develop a healthy-eating plan. Diabetes diet is simply a healthy-eating plan that will help you control your blood sugar.

The plan helps you control your blood sugar (glucose), manage your weight and control heart disease risk factors, such as high blood pressure and high blood fats.

When you eat extra calories and fat, your body creates an undesirable rise in blood glucose. If blood glucose isn't kept in check, it can lead to serious problems, such as a high blood glucose level (hyperglycemia) that, if persistent, may lead to long-term complications, such as nerve, kidney and heart damage.

As glucose in the body comes from foods that contain carbohydrates, people may question whether or not they should eat rice

A person with diabetes does not have to avoid carbs altogether, but they will need to be cautious about the types and quantity of carbs that they eat.

There are different types of rice, some of which may be more healthful than others.

Researchers are of the view that there are three main factors that appear to explain most of the variation in glycemic and insulinaemic responses to rice i.e., the response that rice starch have on blood sugar levels:

  • inherent starch characteristics (rice cultivar and their amylose: amylopectin ratio).

  • processing method (cooking, storage and reheating),

  • post-harvest processing (particularly parboiling).

Rice and the Glycemic Index (GI)

People with prediabetes or diabetes needs to avoid “sugar spikes,” which are periods in which blood glucose levels are very high. These spikes can increase the likelihood of symptoms worsening. Spreading carb intake throughout the day, for example, by eating small, frequent meals, can help prevent sugar spikes.

Glycemic index is a list of foods which dietitians use to select foods, especially carbohydrates. This method ranks carbohydrate-containing foods based on their effect on blood glucose levels. The scores are from 0–100, with water being the lowest and glucose the highest. The numbers do not refer to any specific quantity but look at how one food compares with another.

Diet for Low GI foods are slow to break down during digestion which slows their release of glucose into the bloodstream. High GI foods are broken down easily, flooding the blood with glucose and inspiring a dramatic insulin response.

  • Rice is high in carbs, but some types of rice, such as brown rice, are a whole-grain food. It is recommended that a person with diabetes should get at least half of their daily carbs from whole grains.

When it comes to rice, one-third of a cup of regular, boiled brown rice contains around 15 g of carbohydrate and a little over 1 g of fiber. White rice contains the same number of carbs, but it provides less fiber and fewer nutrients.

Based on GI, the diets including rice are grouped into three categories,

  • low GI (55 or less),

  • medium GI (56 - 69), and

  • high GI (70 or more).

Glycemic load (GL) is an extension of the GI concept. The GL value incorporates the amount of rice in a serving in order to better gauge the impact of a diet on postprandial glucose response.

  • Based on GL, the diets are classified into

  • low GL (10 or less),

  • medium GL (11 - 19), and

  • high GL (20 or more).

Rice variety: higher amylose content for slow release of glucose

Rice contains two types of starches. Amylose and amylopectin. Rice that is high in amylose (typically longer grain rice) has a lower Glycemic Index than rice that is high in amylopectin (typically shorter grain rice).

The molecular structure of amylose is tighter and more compact, thus less susceptible to breakdown than amylopectin whose structure is more vulnerable to digestion.

High amylose rice has notably lower GI values than the high amylopectin variants. They also produce more attenuated insulin responses.

Diabetics should be especially wary of foods low in amylose, though individual reactions can vary.

Apparent amylose content is positively related with water absorption and volume expansion during cooking and with the hardness of boiled rice (Juliano, 2003). Amylose keeps its form while cooking to produce a fluffy result with grains that are separate even when fully cooked. Like the fluffy separated grains of Basmati in pulao or biryani.

Amylopectin rupture to release starch while cooking, so rice high in amylopectin clumps and can be eaten with chopsticks or made into risotto.

Cooking for lesser time attenuated the glycemic response

Several researches have showed that rice cooked for longer times elicited greater glycemic responses.

For instance, Instant white rice boiled for one minute had a GI of 65 compared to instant rice cooked for six minutes which showed a higher GI of 87.

Some processed rice products requiring longer cooking times have higher GIs than those requiring shorter times presumably as a result of gelatinization and a weakened structure. Gelatinization is a process of breaking down the intermolecular bonds of starch molecules in the presence of water and heat, allowing absorption of more water. This irreversibly dissolves the starch granule in water.

Lower gelatinization temperature therefore may indicate lower glycemic response.

A study done on the degree of gelatinization of brown rice cooked by various cooking methods (electric cooking, microwaving, steaming, and conventional boiling) and found that steaming produced the least degree of gelatinization and the lowest GI.

However, steamed rice cakes (Pinto) commonly consumed in the Philippines showed high GI values (80–90) as did steamed Sri Lankan rice noodles (103) .The use of milled rice flour combined with steaming may have caused a greater gelatinization and produced a higher GI in these products.

Mixed meals are better options for diabetes control

As rice is hardly consumed on its own, but in accompaniment with other foods (vegetables, pulses, legumes, nuts, seafood, and meat). Mixed meals are better options for diabetes control.

Studies have indicated that the amount of rapidly digestible starch (RDS) and slowly digestible starch (SDS) can be manipulated relatively simply by varying the type of accompaniments.

Rice flour roti was classified as high GI (103) when consumed without accompaniments.

Rice roti consumed on its own had lower SDS as compared to when it was consumed with coconut chutney. Fish or beans with rice and vegetables can be a good option for people with diabetes.

Beans are low GI, and the attenuated GI of the rice meals was attributed to soluble fiber and antinutrients found in beans. It has been observed that the addition of legumes such as lentils lowers the GI of rice when consumed together.

Dairy products (milk, cheese, and yogurt) significantly reduced the GI of the rice when consumed together. Rice with curry and cheese had a lower GI than rice consumed with curry on its own.

Decreasing Water to Rice ratio while cooking decrease the gelatinization temperature

The water-to-rice ratio during cooking affects the degree of gelatinization and thereby digestibility.

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Parboiled rice : beneficial in lowering blood glucose response

Parboiled rice (also called converted rice and easy-cook rice is rice that has been partially boiled in the husk. The three basic steps of parboiling are soaking, steaming and drying. It is a hydrothermal treatment where the starch in the grain undergoes gelatinization followed by retrogradation. Amylose retrogradation may reduce the glycemic index (GI) through the formation Resistant Starch. Resistant starch is the carbohydrate product that passes through the stomach and small intestine without being broken down, but then might be consumed in the colon by bacteria. Studies suggest that, in comparison to both white rice and brown rice, parboiled rice has a lower impact on blood sugar levels, making it a safer alternative for people with diabetes than other rice.

Cold rice has a lower Glycemic Index

Cooling appears to be a simple and effective intervention to reduce the GI of rice.

Cooling reduces the GI of cooked rice through retrogradation and resultant increase in Resistant Starch (RS) levels. Storing cooked rice at refrigerated temperatures (4°C for 24 hours) led to a reduction in their digestibility and estimated GI for both brown and milled rice.

The highest decrease in starch hydrolysis after cold storing was seen for the waxy cultivars which suggest that high amylopectin rice may be more susceptible to cold-induced retrogradation. Studies have found that aging of noodles in a cold location increased RS formation in rice noodles and lowered the GI. Therefore, cooling seems to reduce the digestibility of both rice grains and processed products.

Pregerminated rice is effective in lowering blood glucose

Pregerminating rice appears to be an effective method of reducing the GI. Germination of rice grains leads to release of free gamma-aminobutyric acid (GABA). The γ-aminobutyric acid (GABA) and dietary fiber of pre-germinated brown rice is higher that white rice. GABA is also known to potentiate the insulin secretion in pancreas.

Gaba-enriched natural products have been evidenced as effective agents in lowering blood glucose, attenuating insulin resistance, stimulating insulin release, and preventing pancreatic damage.

Rice is the main staple in the diets of a large population segment globally. Whilst it contributes a large glycemic load to the diet and thereby potentially promotes impaired glucose tolerance. Suggestions to reduce rice and rice products consumption may not be a sustainable solution. Reducing the Glycemic Index of rice may be the more practical approach to incorporate it in a meal.

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