The Indian Diabetes Challenge: Why You Need To Look Beyond Sugar And Oils

For years, the standard advice on diabetes has been simple: cut down on sugar and reduce oil. However, India's diabetes crisis cannot be explained by sugar or fat alone. The more important question is what we eat, how much we eat and, in the case of fats, what type we consume and how we cook them.

Emerging evidence shows that the relationship between diet and diabetes is shaped by the overall balance of carbohydrates, protein and fats. The quality of these nutrients matters too. Refined carbohydrates and added sugars can increase metabolic risk, while different types of dietary fats can have different effects on insulin sensitivity, glucose metabolism and inflammation. Cooking practices, including the repeated heating of oil, add another important dimension.

Dietary imbalance, a challenge

The national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) survey provides important insights into what we eat. Based on dietary data from 18,090 adults, the survey found that carbohydrates contributed 62.3 per cent of our total daily energy intake, while fat contributed 25.2 per cent and protein only 12 per cent. Refined cereals, milled whole grains and added sugars were important contributors to carbohydrate intake. Higher carbohydrate consumption was associated with a greater likelihood of newly diagnosed type 2 diabetes.

The study also found that simply changing the type of carbohydrate may not be enough. Replacing refined cereals with an equivalent amount of whole wheat or millet, without reducing overall carbohydrate intake, did not lead to a lower risk of type 2 diabetes. In contrast, replacing 5 per cent of calories from carbohydrates with plant or dairy protein was associated with a lower likelihood of type 2 diabetes and prediabetes.

Diabetes and cooking oils

An interesting finding of the ICMR-INDIAB survey was that replacing carbohydrates with total fat, saturated fat, monounsaturated fat or omega-3 polyunsaturated fat did not significantly change the risk of type 2 diabetes or prediabetes. This adds an important angle to the familiar advice to simply "reduce oil". The evidence instead points towards understanding the quality, quantity and source of dietary fat, alongside the rest of the diet.

This is particularly relevant in India, where edible oils are an integral part of cooking. Rather than asking whether an oil is simply "good" or "bad", the focus should be on its fatty-acid profile, how much is consumed and how it is used. Oils with a balanced fatty-acid profile can form part of a healthy dietary pattern, while trans fats should be avoided. Palm oil, for instance, has a naturally balanced mix of saturated and unsaturated fats, including monounsaturated oleic acid similar to that found in olive oil.

How oil is heated and reused also matters. Repeated heating, particularly while frying, can promote oxidation and the formation of undesirable compounds. Palm oil, which has a higher proportion of saturated fat, is naturally more resistant to this kind of oxidation and tends to hold up better under repeated heating. Repeatedly reusing frying oil should, therefore, be avoided.

Edible oils also contain naturally occurring bioactive compounds that may have health benefits. A meta-analysis has found an association between olive oil consumption and a lower risk of type 2 diabetes. High in monounsaturated fatty acids, particularly oleic acid, olive oil also contains compounds such as squalene, tocopherols and polyphenols, which may have favourable effects on insulin sensitivity and the risk of type 2 diabetes. Similarly, palm oil contains tocotrienols, bioactive compounds that are members of the vitamin E family, have antioxidant properties and have been found to help reduce blood cholesterol. Experimental research suggests that tocotrienols may influence glucose utilisation and insulin sensitivity, although more human research is needed to establish their role in diabetes prevention or management.

The message, therefore, is not that fat should be eliminated from the diet. It is that the right fat, in the right amount, used in the right way, deserves a more informed place in the diabetes conversation.

Ultimately, dietary fat cannot be viewed in isolation. A balanced diet that includes appropriate amounts and types of fats, adequate protein, fewer refined carbohydrates and added sugars, along with fruits and vegetables, provides a more sensible foundation for metabolic health. Regular physical activity is equally important, helping the body use glucose more effectively and improving insulin sensitivity. For diabetes prevention, the goal should be a healthier overall dietary pattern, not the elimination of sugar and oils.

(By Prof. Dr Ketan K. Mehta, MD, FCPS, FICP, FISE, FGSI, FDI, FIAMS, Consultant Physician, Cardiopulmonologist and Diabetologist, Mumbai)

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