First-of-its-kind ICMR study reveals food responsible for India’s diabetes epidemic

A new clinical trial has shed light on the role of certain foods in making India the diabetes capital of the world. The study, which is the first of its kind in India, has found that foods rich in advanced glycation end products (AGE) are contributing to the increase in diabetes rates in the country. These AGEs are reactive and potentially harmful compounds that form when proteins or fats combine with sugars. Common foods that contain high levels of AGEs include cakes, potato chips, crackers, fried foods, mayonnaise, margarine, and other ultra-processed products.

The trial, funded by the Indian government and carried out by a group of researchers from institutions such as the Indian Council of Medical Research (ICMR) and the Madras Diabetes Research Foundation (MDRF) in Chennai, highlighted that consumption of foods rich in AGEs triggers inflammation, a key factor in the development of diabetes. The results were published in the International Journal of Food Sciences and Nutrition.

How AGEs contribute to diabetes

AGEs are formed through a non-enzymatic process called glycation, where sugar molecules bind to proteins or fats. This process can lead to the formation of compounds that cause harmful reactions in the body, especially inflammation. Inflammation has been linked to several chronic diseases, including type 2 diabetes.

Dr. V. Mohan, president of MDRF and one of the authors of the paper, explained that glycation is especially important for India’s fight against diabetes. “Understanding which foods are high in AGEs and the cooking methods that increase their formation is crucial to managing diabetes,” Dr. Mohan said.

Diabetes in India

An earlier study by ICMR and MDRF, published in The Lancet Diabetes and Endocrinology in June 2023, revealed alarming statistics. Based on surveys conducted in 31 states and Union Territories between 2008 and 2020, the study found that in 2021, 11.4 per cent of Indians were diabetic. This translates to approximately 10.1 million Indians living with diabetes. The increase in diabetes cases can be attributed to lifestyle changes, including increased consumption of processed and high-EFA foods.

Western research has also shown that highly processed foods, high in fat, sugar, salt and AGEs, increase the risk of chronic diseases. In India, a rapid change in eating habits, coupled with a more sedentary lifestyle, has driven the prevalence of obesity, diabetes and related health conditions. However, data on the impact of AGEs in the Indian diet and their effect on cardiovascular and metabolic health was lacking until now.

The Study: Examining the Effects of Low and High EFA Diets

To explore the impact of AGEs on Indian adults, researchers conducted a clinical trial involving 38 overweight and obese participants. These people, all of whom had a body mass index (BMI) of 25 or more but were not diabetic, were divided into two groups. One group was given a low AGE dietwhile the other followed a high AGE diet for 12 weeks.

The study focused on commonly consumed Indian foods prepared using different cooking methods. High AGE foods were prepared by frying, roasting, or grilling, while low AGE foods were steamed or boiled. Both diets were combined in calories and macronutrients, ensuring that the only variable was the AGE content of the food.

At the end of the 12-week period, the researchers found that participants in the low AGE group showed significant improvements in several key markers of metabolic health. For example, their insulin sensitivity (a measure of how well the body’s cells respond to insulin) improved significantly compared to the high AGE group. Additionally, the low AGE group had lower plasma glucose (PG) levels 30 minutes after loading, which is an indicator of future diabetes risk.

The importance of low AGE diets

The study findings show how food choices and cooking methods can influence the risk of developing type 2 diabetes. By consuming a low-EFA diet, consisting of fruits, vegetables, whole grains, and low-fat dairy products, people can reduce oxidative stress in their bodies. Oxidative stress occurs when there is an imbalance between free radicals and antioxidants, causing cell damage and inflammation. Reducing this stress can help mitigate the risk of obesity-related type 2 diabetes.

Dr. Mohan emphasized the importance of boiling and steaming food instead of frying, roasting or roasting it. “Healthy foods like fruits, vegetables, and whole grains have low levels of AGEs,” he explained. “By avoiding cooking methods that add fats and oils, we can keep dietary AGE levels low.”

What foods are high in AGEs?

Foods high in AGEs include roasted, grilled, or fried products, such as fried chicken, bacon, and beef. Even certain nuts, such as roasted walnuts and sunflower seeds, contain high levels of AGEs due to the cooking process. Additionally, processed plant-based foods and animal proteins are particularly prone to glycation, making them more likely to contain AGEs.

On the other hand, low AGE foods include those that are minimally processed and cooked using methods such as boiling and steaming. Fruits, vegetables, and whole grains are excellent options for a low AGE diet.

Implications for India’s fight against diabetes

The study findings reveal the need for dietary interventions as part of India’s strategy to combat diabetes. As the prevalence of diabetes continues to increase, understanding the role of AGEs in the diet and making changes to reduce their intake could help mitigate the burden of this disease.