metaboliq
Say your HbA1c came back at 6.0 and the doctor said "watch your diet" without saying how. Most of what you'll find online assumes you eat toast, salad and grilled chicken. Your kitchen runs on rice, roti, dal and sabzi, and happily that's the kind of food the big Indian diet studies looked at.
You can keep the rice and the roti, just less of them. Where three katoris of rice used to go, have one and a half, with a full katori of dal and some paneer, curd or an egg beside it. Half the plate can be sabzi or salad. The sugar in your chai and the evening mithai are worth cutting back. If you're carrying extra weight, losing some of it while keeping your muscle does more than any one food.
Is the way we eat at home part of the problem?
For most families, yes, and mostly it's the proportions. The ICMR-INDIAB survey asked more than eighteen thousand adults across India what they actually eat. The usual plate turned out to be loaded with white rice, milled grains and added sugar, with not much protein. The people eating the most carbohydrate had higher odds of prediabetes and of newly found diabetes.
A typical weekday lunch of three katoris of rice with a thin dal and a spoon of aloo sabzi is exactly that pattern. Researchers in Chennai saw it years earlier. Their CURES study found that refined grains, total carbohydrate and glycaemic load all went with newly detected diabetes, while fibre went with lower odds. Pooled studies from Asia, the US and Australia tell the same story about white rice, and the link with diabetes was strongest in the Asian groups.
That's why Indian physicians writing on prediabetes treat diet as the first thing to change. There's a lot of room on the usual plate, and the fixes are mostly about how much rice goes on it and what goes next to it.
Do I have to stop eating rice and roti?
No. The useful questions are how much and with what. In the ICMR-INDIAB analysis, swapping refined flour for whole wheat or millet flour, while eating the same quantity, wasn't linked with lower diabetes risk. A heap of brown rice the same size as yesterday's white rice changes very little.
What the same analysis did link with lower odds of prediabetes was replacing some carbohydrate calories with protein, from pulses, dairy, eggs or fish. In kitchen terms that's one and a half katoris of rice instead of three, with a full katori of dal and a piece of paneer or an egg. Or two rotis instead of four, with a thick dal and a bowl of curd.
Since you're reading this on our site, we should say where we stand. Metaboliq is a doctor-led programme, and our stated aim is "Lose up to 20% of your body weight — and keep your muscle". Results vary; your doctor decides what is right for you. We start with a ₹1,699 blood test at home, and once a doctor has read it, a dietitian works out your rice and roti portions with you.
Whatever your portions end up being, the order you eat in helps. In a small crossover study, eating the vegetables and protein of a meal first and the carbohydrate last gave noticeably lower glucose and insulin afterwards than eating the carbohydrate first. So start lunch with the sabzi, salad and dal, and leave the rice for the end.
Should I switch to millets?
They help, though by less than the packets on the supermarket shelf suggest. A large review of millet studies found that most millets, including ragi, jowar, bajra, kodo and foxtail, have a lower glycaemic index than milled rice or refined wheat. Where people ate millets regularly over time, fasting and after-meal glucose came down, and HbA1c dropped in people with prediabetes.
So if you've just bought a big bag of jowar atta, good. There's a catch in the national data, though. If millet just replaces wheat in the same amount, you're still on a high-carbohydrate, low-protein diet. A ragi dosa with a big potato filling and only coconut chutney is still mostly starch. Millets do the most good when the grain portion shrinks and the dal and vegetables grow.
How you cook them matters too. The same review found that coarse, minimally processed millets lowered a meal's glycaemic index more than finely milled flour. A coarse jowar or ragi roti, bajra khichdi with plenty of moong dal, or foxtail millet cooked like rice all fit. The millet cookies and instant millet noodles you see near the billing counter usually don't, since they're more flour and sugar than grain.
Why do dietitians keep going on about protein?
It keeps you full, for one thing. A review of controlled studies found that higher-protein meals left people feeling fuller, and eating less later, than lower-protein meals with the same calories. With a proper katori of dal at lunch, the biscuit tin at four o'clock is easier to walk past.
Vegetarian homes have to plan for it a little. Dal at two meals, curd or paneer every day, sprouts or roasted chana in the evening, and eggs if you eat them is a reasonable place to start. Rajma, chole and besan chilla all count, and a glass of chaas with lunch is an easy addition. Most of us eat dal as a thin side to the rice, so making it thicker and eating more of it is the simplest change in the whole kitchen.
It matters for your muscle too. When you eat less to lose weight, some muscle goes along with the fat unless you protect it, and the reviews point to enough protein and some strength work. In calorie-cut trials, higher-protein diets kept more lean mass and took off slightly more fat. That's worth having, because muscle is where most of the sugar from your meals ends up.
How much difference does losing weight make?
A lot. The Finnish Diabetes Prevention Study took adults with impaired glucose tolerance and counselled them to lose some weight, cut down on fat and saturated fat, eat more fibre and move more. Their risk of developing diabetes fell by more than half compared with the control group, on fairly modest weight loss.
In an Indian kitchen that Finnish advice translates fairly directly. Eating less fat means measuring the oil for the tadka with a spoon and keeping pakoras for the weekend. More fibre means a bigger bowl of sabzi, whole moong or masoor with the skin on, and fruit you chew instead of juice. Moving more can be a twenty-minute walk after dinner, ideally with whoever else in the family needs one.
Two other studies back this up. When the American Diabetes Prevention Program looked at what had driven its results, weight loss came out on top, with each kilogram lost going with about a 16% lower risk. In China, the Da Qing study followed a similar group for thirty years after diet and activity changes, and diabetes came later for the people who made them.
A realistic day of prediabetes-friendly Indian meals
Breakfast might be a besan chilla full of grated vegetables with mint chutney and a bowl of curd, or two eggs with one roti, or a moong dal dosa with sambar. Have your tea or coffee with milk and no sugar. If that's too big a jump, go down to a quarter of the sugar you take now and taper from there.
For lunch at home or from a tiffin, make half the plate sabzi or salad and add a full katori of dal, rajma or chole. Keep the rice to a smaller portion or two rotis. Curd or buttermilk goes well on the side. In the office canteen, eat the dal and sabzi first and leave a little of the rice.
Around five, a fistful of roasted chana, a handful of peanuts or a cup of sprouts chaat will hold you better than a samosa or biscuits. Dinner can look like lunch with a little less grain, ideally two to three hours before bed. Whole fruit is fine, one piece at a time. Juice is basically sugar in a glass.
At a wedding or a Diwali lunch, start with the paneer and vegetables, pick the one sweet you actually want, and walk for ten minutes afterwards. One festival evening matters far less than the hundred ordinary weekdays around it.
Oil and ghee need a mention. They don't raise blood sugar directly, but they add a lot of calories without anyone noticing, and weight is what moves diabetes risk most. Try measuring the oil for the tadka with a spoon for a week instead of pouring from the bottle. Most families are surprised by how much they use.